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HomeMy WebLinkAbout2009- January File Copy • Jefferson County Board of 3 feaCthi Agenda & wl inutes • January 15, 2009 • JEFFERSON COUNTY BOARD OF HEALTH January 15,2009 Jefferson County Public Health 615 Sheridan Street Port Townsend,WA 2:30—4:30 PM DRAFT AGENDA I. Approval of Agenda II. Approval of Minutes of December 18,2008 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. December Provider Advisories: MRSA and Antiviral Medication Resistant Influenza Strains 2. Public Health Impacts of Heavy Rains and Flooding 3. School-based Clinic Opening—January 2009 • 4. Thank You Letters V. New Business 1 Pharmaceuticals, Personal Care Products, and Water Quality 2. School Immunization Trends—Jefferson County and Washington State 3. Flow Sheet—Boards and Committees related to Substance Abuse Treatment and Prevention 4. Concept Mapping and Strategic Planning- Overview 5. Health Care Community Discussion Forums —Jefferson County Input VI. Activity Update VII. Agenda Planning VIII. Next Scheduled Meeting: February 19, 2009 2:30—4:30 PM Jefferson County Public Health • r � o QbJEFFERSON COUNTY BOARD OF HEALTH OR 1 • MINUTES Thursday, December 18, 2008 2:30 PM—4:30 PM Pope Marine Building, Port Townsend Board Members Staff Members Phil Johnson, County Commissioner District#1 Thomas Locke,MD,Health Officer David Sullivan, County Commissioner,District#2 Jean Baldwin,Public Health Services Director John Austin, Chair, County Commissioner,District#3 Julia Danskin,Nursing Services Director Chuck Russell,Hospital Commissioner,District#2 Michelle Sandoval,Port Townsend City Council Sheila Westerman, Vice Chair, Citizen at large(City) Roberta Frissell, Citizen at large(County) Chair John Austin called the meeting of the Jefferson County Board of Health to order at 2:30 PM. Members Present: John Austin, Phil Johnson, Chuck Russell,David Sullivan, Sheila Westerman Members Excused: Michelle Sandoval, Roberta Frissell Staff Present: Jean Baldwin, Dr. Thomas Locke, Julia Danskin, Veronica Shaw • A quorum was present. APPROVAL OF AGENDA Chair Austin noted that he would not be present for the January meeting and suggested an addition to the agenda, item 5 under New Business: election of new Chair and Vice Chair, to be effective January 1. The agenda was unanimously approved, as amended. [The Public Hearing portion of the meeting was subsequently placed as item 5 on the Agenda, to allow for the arrival of any members of the public who might attend.] APPROVAL OF MINUTES Correction, page 5: The full committee name mentioned by Member Sullivan is Washington State Association of Counties, Coastal Counties Committee. Member Westerman moved for approval of the November 20, 2008 minutes, as amended. The motion was seconded by Member Russell and approved by unanimous vote. • PUBLIC COMMENTS There were no public comments. • OLD BUSINESS Flu View 2008-09 Influenza Surveillance Data Dr. Locke discussed the influenza surveillance report included in the Board's packet, noting that this is representative of the type of weekly data available about influenza activity. Of the many viruses associated with upper respiratory infection, influenza is of special public health concern due to its ability to cause serious illness and death. The annualized excess mortality rate for influenza is 36,000 per year in the US; the great majority of these are elderly patients. Influenza activity is low nationwide. Dr. Locke noted many factors contribute to the seasonal rise in flu cases: time spent indoors, cooler temperatures, and extensive travel over the winter holidays. School-aged children are an especially important factor is influenza outbreaks—the virus is spread in school settings among children and then passed on to adult family members. There has been significant change in the antigenic character of the flu strains circulating. This year all three components of the flu vaccine had to be modified. Thus far, the choice of isolates seems to be a good match for circulating strains. The bad news is that H1N1 virus stain (which made its first appearance as the "Spanish Influenza"pandemic of 1918) continues to circulate throughout the world and has become resistant to the widely used antiviral medication oseltamivir("Tamiflu"). This is the same medication that is being stockpiled • to protect against a future influenza pandemic. The message is that antiviral medications are not a reliable defense against influenza. Vaccines and respiratory precautions are the best defense. Member Westerman inquired as to "normal" flu rates for various regions of the USA. That is, what are considered to be normal and abnormal number of cases. Dr. Locke explained the chart on page 1 of the FluView report and also referred to the graph on page 4, which shows the normal distribution of seasonal mortality rates as well as the epidemic threshold levels for the past four years. He described the data collection process, which includes ILI (influenza-like illness) counts from sentinel physicians to the Centers for Disease Control (CDC). If the count on any given week is higher than expected, that would be a possible indicator of a flu outbreak. School absenteeism rates in excess of 10% are also used as markers for influenza activity. Chair Austin asked for status on flu shot participation in Jefferson County this year. Jean Baldwin said that the amount of State supplied vaccine is tracked, but this is not the total supply. The vaccines administered by Safeway, QFC and some others are not included. There has been greater emphasis on flu vaccination for children by the CDC. However, this year Washington State chose to purchase most childhood influenza vaccine in the injectable form rather than the increasingly popular intranasal mist form ("FluMist"). Since an injection is required, that has been a factor in decreasing the numbers of children S vaccinated. The percentage of hospital health care and health department employees in Jefferson County that were vaccinated was very high. Unfortunately, there is no real- • time system for tracking influenza vaccination rates and most information is only available after flu season when total doses distributed and administered are finally known. EPI-Trends—Washington Surveillance for Severe Influenza Disease Dr. Locke discussed how the public health system deals with severe influenza. First, there is surveillance in key areas, such as childhood deaths associated with influenza and adult mortality rates. The immunization strategy in the past was to vaccinate everyone who was at risk for influenza complications. However, the vaccine was not very effective in the elderly and cannot be given to infants under the age of six months. The current strategy is to surround those at high risk for influenza complications with caretakers and family members who are vaccinated. People with healthy immune systems are the primary targets for immunization since they are far more likely to develop protective immunity after influenza vaccination. Emergency Preparedness Mutual Aid Agreements: Multi-County and Multi-Tribe Dr. Locke noted that development of mutual aid agreements as part of emergency preparedness activities. He noted that these agreements have been standard for government agencies such as police, fire and emergency medical services but that they have not been widely used by public health jurisdictions. There is now recognition that • for pandemic or other emergency public health problems, local resources would be quickly exhausted and there would be the need to bring in fully trained reinforcements. He described two processes that have grown out of this recognition. The"Public Health Inter jurisdictional Mutual Aid Agreement" is an agreement between Kitsap County, Seattle/King Public Health, Snohomish Health District, Tacoma/Pierce Health District, and others. It was developed as a model with the expectation that other districts would join in. From a policy standpoint, consideration should begin with the Board of Health, but the County Commissioners would likely be the responsible signers of the document. Dr. Locke suggested that the question as to the appropriate signatories could be answered by county attorney David Alvarez. Member Westerman said she found the document to be quite comprehensible and rational. Dr. Locke noted that the Counties that are already party to this agreement have registered all employees as emergency health workers in the State database. This allows efficient automatic payment for resources expended. Otherwise, financial reconciliation following an emergency can take considerable time. Chair Austin also noted the value of having an agreement in place, including the avoidance of uncontrolled costs. Chair Westerman moved that the BOH make a recommendation to the BOCC for approval of this agreement, subject to review by the County Attorney and determination as to the appropriate signatories. Member Russell seconded the motion. The motion was approved unanimously. • Dr. Locke described the second mutual aid agreement in development involving the Tribal Health Jurisdictions. There is considerable legal uncertainty about the overlapping • jurisdictions of local health departments/districts and sovereign tribal governments. Approximately six months ago Region 2 (Jefferson, Kitsap, Clallam)public health officials were asked if they wished to apply for some unused pandemic influenza preparedness funding. He said that the three counties share borders with 7 Tribes and have a history of close working relations with them, making the region an ideal place to develop a draft agreement for mutual aid in health emergencies between tribes and local health jurisdictions. The lawyer who negotiated the first agreement was hired to assist with this process. A grant of$140,000 was awarded to pursue this project; Kitsap County, as the lead county in the Region, will administer it. Dr. Locke reported that he and Dr. Scott Lindquist had contacted tribal leaders, who were all enthusiastic about the project. Coastal tribes in particular experience power outages, flooding and other emergencies frequently. He noted that there are a number of informal aid agreements in place, but nothing formal and binding. Chair Austin questioned why the Quinault tribe was not included and was informed that the Quinault tribe works with Gray's Harbor County and are considered to be outside of Region 2, as is the Queets tribe. It is hoped that the model agreement developed by Region 2 will be used in the future by tribes and counties statewide. There was additional discussion about the scope and purpose of this agreement. The first meeting will be held on January 7 in Port Angeles, with subsequent meetings to be held at different locations. The goal is to finalize the agreement by August, 2009 including identification and resolution of any contentious issues. Dr. Locke said he would keep the BOH posted on developments and . will bring the completed document forward when ready. Department of Health Proposed Budget Cuts for Remainder of 2007-2009 Biennium Jean Baldwin noted that the Governor had released her 2009-2011 budget and the 2009 supplemental budget, which includes cuts of$6.1 million by June 2009. None of the cuts affect the Health Department directly. No contracts within the Department are in jeopardy at this time. Detailed budgets can be viewed on the Governor's page of the OFM website. There are cuts to Healthcare, DSHS, Ecology and CTED, which are the main funding sources for the department. Ms. Baldwin described proposed changes to the State program of buying vaccines. The State spends $49 million annually on vaccines to assure that all children have access to needed immunization. This supplements the federal Vaccines for Children (VFC) program that provides free vaccine for children who meet federal eligibility criteria (about 60% of kids). The vaccine is distributed free of charge and insurance companies pay for the cost of administering the shots. Since the children receiving state sponsored vaccine are mostly insured,the rationale for these budgets cuts is to shift the cost of these vaccines from the states to the health insurance plans. There is a form of cost shifting, but there are no cuts to local public health or local government funding and no change to • flexible spending. She said that there is likely to be strong opposition to the cuts in the . vaccine program. Ms. Baldwin reported small cuts to the Health Department in the Passport program, which is a DSHS contract program. Some cuts, such as General Assistance for the Unemployable (GAU) will seriously impact the community. GAU is a Medicaid-like program that is entirely state funded. Mental health related decreases appear to be about 5 to 7%; substance abuse funding will drop about 2%. There is also a 5% reduction in the First Step program, which has shown success in dealing with infant mortality, and reshifting of funds to only high risk cases. She said the MCH (Maternal Child Health) staff is concerned about the possible lack of funding for their program, as other counties have decreased funding. Ms. Baldwin asked the Board to consider the draft letter to the Governor in support of the First Steps program. She said that she believes both Governor Gregoire and Representative Lynn Kessler need to hear from local officials about the value of this program for their communities. She expects there will be vigorous lobbying about budget cuts by the start of the New Year, and fears that the voice for maternal health may not be heard otherwise. She added that Lynn Kessler needs to know the importance of maternal funding for Jefferson County, which includes both the Hospital and the Health Department. She noted that this program has positively changed birth outcomes and is also the funding stream for Nurse Family Partnership. Member Westerman said she was supportive of the draft letter, and suggested corrections • including: addition of commas; correction to "Secretary of Health (from Secretary of State), and deletion of the second "will be" at the end of the third paragraph. She suggested "health ramifications" in the first sentence of paragraph four. She also suggested addition of a final sentence to paragraph four: "Not doing so is a clear case of Penny wise and pound foolish." She emphasized that the BOH should make clear that it believes such cuts would not result in savings. Member Johnson moved to direct the Chair to sign the amended letter; Member Sullivan seconded. The motion was approved unanimously. It was agreed that the Jefferson Hospital Board would be copied on the letter. There was additional discussion acknowledging that the Puget Sound Partnership is likely to take up portions of the funding related to water quality and monitoring. However, there is still uncertainty about the net impact on important programs. Jean Baldwin also distributed materials from the National Association of County and City Health Officials (NACCHO) regarding their recommendations to the Presidential Transition Team on Health Policy and Reform Goals for funding/rebuilding of infrastructure and modernization of systems. NACCHO wishes to ensure that local public health issues are considered in the broader national discussion. As part of the effort to collect community input nationwide, designated teams will be holding local forums on health care reform. There will be one held on December 20 from 1:00 to 3:00 • PM at the Port Townsend Community Center. Other sessions are planned for December 27 and January 10. Sessions are open to all. . Jefferson County Public Health Strategic Planning: Follow-Up Jean Baldwin outlined a project undertaken by the management team and lead staff to determine priorities and goals, and internal capacities needed to reach those goals. The packet materials are copies of draft web site pages which link to specific goals and capacities. Ms. Baldwin said she was seeking BOH input on the goals, which are foundational to the remaining planning work. She said she hopes to use this approach in developing priorities and plans in the coming year. Chair Austin noted that"Supporting Economic Health" is a general goal for virtually every department. Ms. Baldwin explained that child care services and family services for unintended pregnancy are both aimed at keeping people in the work force, hence the linkage to economic health. Member Westerman suggested that"Building Capacity for Sustainable Public Health" should become the key goal with"Supporting Economic Health" as a supporting element. She also suggested that "Reducing Cost Burden..." could be in a subordinate position to Supporting Economic Health. Jean Baldwin explained that, in working through this exercise, staff realized how the same generic process and prioritization is applied for dealing with on site environmental health complaints as for child abuse referrals to CPS. Further, it makes clear why some functions "belong" under Public Health, and not elsewhere. However, there is still uncertainty as to how this process will lead to prioritizations that can be applied when • expected budget cuts must be made. She explained that this is merely a beginning. She would like to place this on the agenda for BOH discussion early in the year. Election of BOH Chair and Vice Chair for 2009 Chair Austin asked for nominations for the position of Chair. (He said that, for purposes of public disclosure, he had asked Chuck Russell if he would be willing to be nominated for Vice Chair.) Chair Austin nominated Sheila Westerman for BOH Chair,which was seconded by Member Russell. There were no other nominations. BOH members unanimously approved Member Westerman as Chair, effective January 1, 2009. Member Johnson nominated Member Russell for the position of Vice Chair, which was seconded by Member Sullivan. Member Russell was unanimously elected as Vice Chair. Public Hearing: Jefferson County Public Health Fee Revisions Veronica Shaw explained the updates and changes that had been made to the Fee Schedule documents since the previous meeting. She noted formatting changes and expansion of acronyms for ease of reading. She also explained that the CPI of 4.9% had • I been applied to the 2008 figures to arrive at the 2009 fees. Ordinance language was • updated per the BOH recommendations at the previous meeting. Member Westerman suggested that the term "Permit Fees"be added under Food Service Establishments, Immediate Consumption and Not For Immediate Consumption. Under "Other Food Fees, Reinspection", she requested that First Inspection and Second Inspection be changed to First Reinspection and Second Reinspection. Member Westerman also inquired as to how the license fees for Onsite Sewage Disposal— Installer, Pumper, etc are determined. Jean Baldwin said that these fees had been cost based and found to be very close to CPI derived figures. In general, Jefferson County fees are lower than other counties. Member Westerman said she appreciated the larger, easier to read format. Member Russell asked why Jefferson County fees are lower than other counties. Jean Baldwin said this was due to the fact that labor costs and overhead are less. However, she said that in the future certain additional costs such as apportioned management costs should be included in the fees. There was a brief discussion as to the effects of operational scale on the fees and the impact of decreasing volumes for permits due to the general economy. There were no comments from the public; Chair Austin closed the public portion of the hearing. There was clarification that an Ordinance number would be assigned following approval • by the BOH. Member Westerman moved for approval of the Ordinance Establishing a Fee Schedule for Jefferson County Health, as amended. Member Johnson seconded the motion. The motion was approved unanimously. Activity Update Julia Danskin noted that a check for $225 had been given to the Health Department by Port Ludlow Yacht Club Women's Group, from the sale of their cookbooks. A letter of thanks will be mailed. Agenda Planning The next BOH meeting is scheduled for Thursday, January 15 and will be held at the Jefferson County Health Department. Agenda will include continuation of the discussion on strategic planning, goals and capacity. Adjournment Member Johnson moved for adjournment; Member Sullivan seconded. Chair Austin adjourned the meeting at 3:59 PM. i S JEFFERSON COUNTY BOARD OF HEALTH • John Austin, Chair Sheila Westerman, Vice Chair Excused Roberta Frissell, Member Chuck Russell, Member Phil Johnson, Member David Sullivan, Member Excused Michelle Sandoval, Member • • f • JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, December 18, 2008 2:30 PM—4:30 PM Pope Marine Building, Port Townsend Board Members Staff Members Phil Johnson, County Commissioner District#1 Thomas Locke,MD,Health Officer David Sullivan, County Commissioner,District#2 Jean Baldwin,Public Health Services Director John Austin, Chair, County Commissioner,District#3 Julia Danskin,Nursing Services Director Chuck Russell,Hospital Commissioner,District#2 Michelle Sandoval,Port Townsend City Council Sheila Westerman, Vice Chair, Citizen at large(City) Roberta Frissell, Citizen at large(County) Chair John Austin called the meeting of the Jefferson County Board of Health to order at 2:30 PM. Members Present: John Austin, Phil Johnson, Chuck Russell, David Sullivan, Sheila Westerman Members Excused: Michelle Sandoval, Roberta Frissell Staff Present: Jean Baldwin, Dr. Thomas Locke, Julia Danskin, Veronica Shaw A quorum was present. APPROVAL OF AGENDA Chair Austin noted that he would not be present for the January meeting and suggested an addition to the agenda, item 5 under New Business: election of new Chair and Vice Chair, to be effective January 1. The agenda was unanimously approved, as amended. [The Public Hearing portion of the meeting was subsequently placed as item 5 on the Agenda, to allow for the arrival of any members of the public who might attend.] APPROVAL OF MINUTES Correction, page 5: The full committee name mentioned by Member Sullivan is Washington State Association of Counties, Coastal Counties Committee. Member Westerman moved for approval of the November 20, 2008 minutes, as amended. The motion was seconded by Member Russell and approved by unanimous vote. PUBLIC COMMENTS There were no public comments. • OLD BUSINESS Flu View 2008-09 Influenza Surveillance Data Dr. Locke discussed the influenza surveillance report included in the Board's packet, noting that this is representative of the type of weekly data available about influenza activity. Of the many viruses associated with upper respiratory infection, influenza is of special public health concern due to its ability to cause serious illness and death. The annualized excess mortality rate for influenza is 36,000 per year in the US; the great majority of these are elderly patients. Influenza activity is low nationwide. Dr. Locke noted many factors contribute to the seasonal rise in flu cases: time spent indoors, cooler temperatures, and extensive travel over the winter holidays. School-aged children are an especially important factor is influenza outbreaks—the virus is spread in school settings among children and then passed on to adult family members. There has been significant change in the antigenic character of the flu strains circulating. This year all three components of the flu vaccine had to be modified. Thus far, the choice of isolates seems to be a good match for circulating strains. The bad news is that H1N1 virus stain(which made its first appearance as the"Spanish Influenza"pandemic of 1918) continues to circulate throughout the world and has become resistant to the widely used antiviral medication oseltamivir ("Tamiflu"). This is the same medication that is being stockpiled • to protect against a future influenza pandemic. The message is that antiviral medications are not a reliable defense against influenza. Vaccines and respiratory precautions are the best defense. Member Westerman inquired as to "normal"flu rates for various regions of the USA. That is, what are considered to be normal and abnormal number of cases. Dr. Locke explained the chart on page 1 of the FluView report and also referred to the graph on page 4, which shows the normal distribution of seasonal mortality rates as well as the epidemic threshold levels for the past four years. He described the data collection process, which includes ILI (influenza-like illness) counts from sentinel physicians to the Centers for Disease Control (CDC). If the count on any given week is higher than expected, that would be a possible indicator of a flu outbreak. School absenteeism rates in excess of 10% are also used as markers for influenza activity. Chair Austin asked for status on flu shot participation in Jefferson County this year. Jean Baldwin said that the amount of State supplied vaccine is tracked, but this is not the total supply. The vaccines administered by Safeway, QFC and some others are not included. There has been greater emphasis on flu vaccination for children by the CDC. However, this year Washington State chose to purchase most childhood influenza vaccine in the injectable form rather than the increasingly popular intranasal mist form ("FluMist"). Since an injection is required, that has been a factor in decreasing the numbers of children vaccinated. The percentage of hospital health care and health department employees in • Jefferson County that were vaccinated was very high. Unfortunately,there is no real- time system for tracking influenza vaccination rates and most information is only available after flu season when total doses distributed and administered are finally known. EPI-Trends—Washington Surveillance for Severe Influenza Disease Dr. Locke discussed how the public health system deals with severe influenza. First, there is surveillance in key areas, such as childhood deaths associated with influenza and adult mortality rates. The immunization strategy in the past was to vaccinate everyone who was at risk for influenza complications. However, the vaccine was not very effective in the elderly and cannot be given to infants under the age of six months. The current strategy is to surround those at high risk for influenza complications with caretakers and family members who are vaccinated. People with healthy immune systems are the primary targets for immunization since they are far more likely to develop protective immunity after influenza vaccination. Emergency Preparedness Mutual Aid Agreements: Multi-County and Multi-Tribe Dr. Locke noted that development of mutual aid agreements as part of emergency preparedness activities. He noted that these agreements have been standard for government agencies such as police, fire and emergency medical services but that they • have not been widely used by public health jurisdictions. There is now recognition that for pandemic or other emergency public health problems, local resources would be quickly exhausted and there would be the need to bring in fully trained reinforcements. He described two processes that have grown out of this recognition. The"Public Health Inter jurisdictional Mutual Aid Agreement" is an agreement between Kitsap County, Seattle/King Public Health, Snohomish Health District, Tacoma/Pierce Health District, and others. It was developed as a model with the expectation that other districts would join in. From a policy standpoint, consideration should begin with the Board of Health, but the County Commissioners would likely be the responsible signers of the document. Dr. Locke suggested that the question as to the appropriate signatories could be answered by county attorney David Alvarez. Member Westerman said she found the document to be quite comprehensible and rational. Dr. Locke noted that the Counties that are already party to this agreement have registered all employees as emergency health workers in the State database. This allows efficient automatic payment for resources expended. Otherwise, financial reconciliation following an emergency can take considerable time. Chair Austin also noted the value of having an agreement in place, including the avoidance of uncontrolled costs. Chair Westerman moved that the BOH make a recommendation to the BOCC for approval of this agreement, subject to review by the County Attorney and determination as to the appropriate signatories. Member Russell seconded the motion. The motion was approved unanimously. Dr. Locke described the second mutual aid agreement in development involving the • Tribal Health Jurisdictions. There is considerable legal uncertainty about the overlapping jurisdictions of local health departments/districts and sovereign tribal governments. Approximately six months ago Region 2 (Jefferson, Kitsap, Clallam)public health officials were asked if they wished to apply for some unused pandemic influenza preparedness funding. He said that the three counties share borders with 7 Tribes and have a history of close working relations with them, making the region an ideal place to develop a draft agreement for mutual aid in health emergencies between tribes and local health jurisdictions. The lawyer who negotiated the first agreement was hired to assist with this process. A grant of$140,000 was awarded to pursue this project; Kitsap County, as the lead county in the Region, will administer it. Dr. Locke reported that he and Dr. Scott Lindquist had contacted tribal leaders, who were all enthusiastic about the project. Coastal tribes in particular experience power outages, flooding and other emergencies frequently. He noted that there are a number of informal aid agreements in place, but nothing formal and binding. Chair Austin questioned why the Quinault tribe was not included and was informed that the Quinault tribe works with Gray's Harbor County and are considered to be outside of Region 2, as is the Queets tribe. It is hoped that the model agreement developed by Region 2 will be used in the future by tribes and counties statewide. There was additional discussion about the scope and purpose of this agreement. The first meeting will be held on January 7 in Port Angeles, with subsequent meetings to be held at different locations. The goal is to finalize the agreement by August, 2009 including identification and resolution of any contentious issues. Dr. Locke said he would keep the BOH posted on developments and will bring the completed document forward when ready. Department of Health Proposed Budget Cuts for Remainder of 2007-2009 Biennium Jean Baldwin noted that the Governor had released her 2009-2011 budget and the 2009 supplemental budget, which includes cuts of$6.1 million by June 2009. None of the cuts affect the Health Department directly. No contracts within the Department are in jeopardy at this time. Detailed budgets can be viewed on the Governor's page of the OFM website. There are cuts to Healthcare, DSHS, Ecology and CTED, which are the main funding sources for the department. Ms. Baldwin described proposed changes to the State program of buying vaccines. The State spends $49 million annually on vaccines to assure that all children have access to needed immunization. This supplements the federal Vaccines for Children (VFC) program that provides free vaccine for children who meet federal eligibility criteria (about 60% of kids). The vaccine is distributed free of charge and insurance companies pay for the cost of administering the shots. Since the children receiving state sponsored vaccine are mostly insured, the rationale for these budgets cuts is to shift the cost of these vaccines from the states to the health insurance plans. There is a form of cost shifting, but there are no cuts to local public health or local government funding and no change to • flexible spending. She said that there is likely to be strong opposition to the cuts in the . vaccine program. Ms. Baldwin reported small cuts to the Health Department in the Passport program, which is a DSHS contract program. Some cuts, such as General Assistance for the Unemployable (GAU) will seriously impact the community. GAU is a Medicaid-like program that is entirely state funded. Mental health related decreases appear to be about 5 to 7%; substance abuse funding will drop about 2%. There is also a 5% reduction in the First Step program, which has shown success in dealing with infant mortality, and reshifting of funds to only high risk cases. She said the MCH (Maternal Child Health) staff is concerned about the possible lack of funding for their program, as other counties have decreased funding. Ms. Baldwin asked the Board to consider the draft letter to the Governor in support of the First Steps program. She said that she believes both Governor Gregoire and Representative Lynn Kessler need to hear from local officials about the value of this program for their communities. She expects there will be vigorous lobbying about budget cuts by the start of the New Year, and fears that the voice for maternal health may not be heard otherwise. She added that Lynn Kessler needs to know the importance of maternal funding for Jefferson County, which includes both the Hospital and the Health Department. She noted that this program has positively changed birth outcomes and is also the funding stream for Nurse Family Partnership. • Member Westerman said she was supportive of the draft letter, and suggested corrections including: addition of commas; correction to "Secretary of Health (from Secretary of State), and deletion of the second "will be" at the end of the third paragraph. She suggested "health ramifications" in the first sentence of paragraph four. She also suggested addition of a final sentence to paragraph four: "Not doing so is a clear case of Penny wise and pound foolish." She emphasized that the BOH should make clear that it believes such cuts would not result in savings. Member Johnson moved to direct the Chair to sign the amended letter; Member Sullivan seconded. The motion was approved unanimously. It was agreed that the Jefferson Hospital Board would be copied on the letter. There was additional discussion acknowledging that the Puget Sound Partnership is likely to take up portions of the funding related to water quality and monitoring. However, there is still uncertainty about the net impact on important programs. Jean Baldwin also distributed materials from the National Association of County and City Health Officials (NACCHO) regarding their recommendations to the Presidential Transition Team on Health Policy and Reform Goals for funding/rebuilding of infrastructure and modernization of systems. NACCHO wishes to ensure that local public health issues are considered in the broader national discussion. As part of the effort to collect community input nationwide, designated teams will be holding local forums on health care reform. There will be one held on December 20 from 1:00 to 3:00 • PM at the Port Townsend Community Center. Other sessions are planned for December 27 and January 10. Sessions are open to all. • Jefferson County Public Health Strategic Planning: Follow-Up Jean Baldwin outlined a project undertaken by the management team and lead staff to determine priorities and goals, and internal capacities needed to reach those goals. The packet materials are copies of draft web site pages which link to specific goals and capacities. Ms. Baldwin said she was seeking BOH input on the goals, which are foundational to the remaining planning work. She said she hopes to use this approach in developing priorities and plans in the coming year. Chair Austin noted that"Supporting Economic Health" is a general goal for virtually every department. Ms. Baldwin explained that child care services and family services for unintended pregnancy are both aimed at keeping people in the work force, hence the linkage to economic health. Member Westerman suggested that "Building Capacity for Sustainable Public Health" should become the key goal with "Supporting Economic Health" as a supporting element. She also suggested that"Reducing Cost Burden..." could be in a subordinate position to Supporting Economic Health. Jean Baldwin explained that, in working through this exercise, staff realized how the same generic process and prioritization is applied for dealing with on site environmental health complaints as for child abuse referrals to CPS. Further, it makes clear why some functions"belong" under Public Health, and not elsewhere. However,there is still 110 uncertainty as to how this process will lead to prioritizations that can be applied when expected budget cuts must be made. She explained that this is merely a beginning. She would like to place this on the agenda for BOH discussion early in the year. Election of BOH Chair and Vice Chair for 2009 Chair Austin asked for nominations for the position of Chair. (He said that, for purposes of public disclosure, he had asked Chuck Russell if he would be willing to be nominated for Vice Chair.) Chair Austin nominated Sheila Westerman for BOH Chair,which was seconded by Member Russell. There were no other nominations. BOH members unanimously approved Member Westerman as Chair, effective January 1, 2009. Member Johnson nominated Member Russell for the position of Vice Chair, which was seconded by Member Sullivan. Member Russell was unanimously elected as Vice Chair. Public Hearing: Jefferson County Public Health Fee Revisions Veronica Shaw explained the updates and changes that had been made to the Fee Schedule documents since the previous meeting. She noted formatting changes and expansion of acronyms for ease of reading. She also explained that the CPI of 4.9%had • been applied to the 2008 figures to arrive at the 2009 fees. Ordinance language was • updated per the BOH recommendations at the previous meeting. Member Westerman suggested that the term "Permit Fees" be added under Food Service Establishments, Immediate Consumption and Not For Immediate Consumption. Under "Other Food Fees, Reinspection", she requested that First Inspection and Second Inspection be changed to First Reinspection and Second Reinspection. Member Westerman also inquired as to how the license fees for Onsite Sewage Disposal— Installer, Pumper, etc are determined. Jean Baldwin said that these fees had been cost based and found to be very close to CPI derived figures. In general, Jefferson County fees are lower than other counties. Member Westerman said she appreciated the larger, easier to read format. Member Russell asked why Jefferson County fees are lower than other counties. Jean Baldwin said this was due to the fact that labor costs and overhead are less. However, she said that in the future certain additional costs such as apportioned management costs should be included in the fees. There was a brief discussion as to the effects of operational scale on the fees and the impact of decreasing volumes for permits due to the general economy. There were no comments from the public; Chair Austin closed the public portion of the hearing. • There was clarification that an Ordinance number would be assigned following approval by the BOH. Member Westerman moved for approval of the Ordinance Establishing a Fee Schedule for Jefferson County Health, as amended. Member Johnson seconded the motion. The motion was approved unanimously. Activity Update Julia Danskin noted that a check for$225 had been given to the Health Department by Port Ludlow Yacht Club Women's Group, from the sale of their cookbooks. A letter of thanks will be mailed. Agenda Planning The next BOH meeting is scheduled for Thursday, January 15 and will be held at the Jefferson County Health Department. Agenda will include continuation of the discussion on strategic planning, goals and capacity. Adjournment Member Johnson moved for adjournment; Member Sullivan seconded. Chair Austin adjourned the meeting at 3:59 PM. • 4 JEFFERSON COUNTY BOARD OF HEALTH • (c4r, ' 4 0 I c4e.„l A.Labii',' ____„ Johj Austi Chair Sheila Westerman, Vice Chair Excused Roberta Frissell?Member Chuc 1ussel , M ber j ( ', aiiPhil Johnsr.►, Member Davi ullivan, Member Excused Michelle Sandoval, Member • • Board of 3-fealth Old Business Agenda Items # 1 December Provider .advisories: • NIRSA & Antiviral.Medication Resistant Influenza Strains January 15, 2009 1 4 ' JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org • Methicillin-resistant Staphylococcus aureus (MRSA) Guidelines for Jefferson County Medical Providers: December 22, 2008 Dear Jefferson County Medical Providers, Recent media attention has highlighted our need to have a current understanding of Staphylococcus aureus and MRSA in particular. As an Infectious Disease specialist, I have always regarded S. aureus as a common and potentially life-threatening pathogen. The most frustrating thing about this infection is its persistent and recurrent nature. Long before MRSA was common, we had a problem with S aureus colonization, abscesses, recurrent abscesses, pneumonia, sepsis, osteomyelitis, meningitis, etc. Now we have an additional frustration, the development of drug resistance. Since the 1960's we have seen the emergence of drug resistant forms of S aureus (MRSA)that were associated with hospitalization and long term care facilities.. Today, MRSA is found commonly in the community. This means transmission occurs in your offices as well as in hospitals and long term care facilities and the community. MRSA is not a 'superbug.' There are still antibiotics effective against MRSA; however, • we need to pay as much attention to our infection control practices that prevent the spread of infections (including Staphylococcus) as we do to our prescribing practices. In response to increasing multi-drug resistant infections in hospitals in 2008, Washington State Department of Health convened an Expert Panel on Evidence-Based Monitoring Strategies and Interventions for Antibiotic Resistant Organisms. The panel recommends that hospitals be more judicious in the use of antibiotics so that the remaining antibiotics continue to be effective, we standardize the implementation of the guidelines developed by the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee and published as Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006 (http://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroguideline2006.pdf). These guidelines focus on the routine implementation of evidence-based processes known as performance bundles to prevent central line infections and promote best ventilator care to prevent occurrence and transmission of infections due to multidrug-resistant organisms. Mandatory MRSA screening and isolation remain controversial among national experts and for that reason were not recommended by the expert panel. The debate about their value continues because of the limited reports of success so far. Reported were the failure of screening, the costs of screening and isolation, the unwanted side effects of patient isolation, the inability to find sufficient isolation rooms in older hospitals with 2-bed patient rooms, and the fact that methicillin-susceptible S. aureus still • TY HEALTH DEEVELOPIMENTAL DISABILITIES PUBLIC HEALTH ENVIRONMENTAL A ER QUALITY MAIN: (360)385-9400 ALWAYS WORKING FOR A SAFER AND MAIN: (360)385-9444 FAX: (360)385-9401 HEALTHIER COMMUNITY FAX: (360)379-4487 constitutes an important infection control challenge in US hospitals. Patient populations who should be screened are not well defined and vary among published reports and the optimal timing and interval of screening tests are not well defined. More research is • needed to determine the circumstances under which screening cultures are most beneficial, but the Expert Panel endorsed that screening should be considered at this time in some settings, especially if other control measures have been ineffective. I recommend we treat every patient as if they are colonized with S aureus (including MRSA) and follow infection control guidelines that account for this possibility. These are called Standard Precautions! I have enclosed several resources for medical providers: The first is a reminder of the standard hospital Infection Control Policy as it applies to S aureus. Secondly, I have included a link to the "MRSA Toolkit for Outpatient Clinics and Offices" as prepared by the Washington State Department of Health and Tacoma-Pierce County Health Department. This is a must read and is excellent! If you read through this toolkit, you will be ready to answer staff, patient and provider questions. Most importantly, if these practices are instituted, you will control and reduce the spread of MRSA (as well as other infections) within your workplace. I. Hospital-based infection control focuses on ALL potential pathogens. Because patients can be unknown carriers of various types of pathogens, hospital infection control policy requires a set of precautions known as Standard Precautions that applies to everyone. These are designed to prevent the spread of both known and unknown pathogens and include the use of gloves and gowns when in contact with blood, body fluid and open • wounds or skin sores. To prevent infections, an ongoing focus on hand hygiene is essential, because this is best way to stop the spread of germs. Increasingly, patients are being encouraged to speak up if they haven't seen their caregiver clean their hands before touching them. Please don't be offended, but be aware that patients are becoming better educated about hand washing and more proactive about their care. Patients with any type of active, non-contained infection (including MRSA infections) are placed in a private room whenever possible. If none is available, patients with like- infections are placed together. Patients, who are high risk(e.g. immune compromised) or are having heart or joint surgery, are placed in a private room whenever possible. If none is available, they will be placed with another non-infected patient having a similar type of surgery. II. The MRSA toolkit for outpatient clinics and offices was created by the Washington State Department of Health and the Tacoma-Pierce County Health Department for clinicians. This toolkit has been designed to help staff at outpatient clinics and medical offices prevent, diagnose, treat and reduce the transmission of MRSA. It contains new educational materials for everyone: clinic staff, health care providers and patients. The link to this site is: COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES AIMS WORKING FOR WATER QUALITY MAIN: 360385-9400MAIN: 360385-9444 • FAX: 360385-9401 HEALTHIER COMMUNITY FAX: 364379-4487 http://www.tpchd.org/page.php?id=336 • Suggestions for Use: 1. Use the Policy/Procedure Check-off List to determine if your clinic/office has the basic policies and procedures for infection control in place. 2. Check to see if clinic policies and procedures are being followed. Perform routine assessments of clinic worker behaviors using the Assessment of Clinical Practice tool. Perform these assessments on a regular basis to track success in changing and implementing policy/procedures and motivating staff to use infection control and prevention measures. 3. Ask all staff to attend the PowerPoint presentation (provided), followed by a question and answer session. 4. Review all toolkit materials with staff so they will know what is available to educate/update clinic staff, medical providers and patients. III. Patient information(pamphlet) "Living with MRSA" which educates patients on how to control the spread of MRSA. • The link to this site is: http://www.tpchd.org/files/library/72640dd923f76e37.pdf Suggestions for Use: 1. Educate patients (and their parents/care givers) about the appropriate use of antibiotics and about recognizing, treating and preventing transmission of skin and soft tissue infections. Talk with them, answer questions and teach them while you are providing treatment. Follow up with patient-targeted educational materials. Remind them that frequent, thorough hand washing is the best way to prevent infections. 2. Provide information that is specifically targeted to patients. Hang informational posters in the waiting areas and examination/treatment room. Provide pamphlets patients can take with them to reinforce what they have just learned, to share information with others. Give "Living with MRSA"to patients and families who are dealing with COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES U r; r WATER QUALITY • MAIN: 360385-9400 ALNAYS�`�`ORKING R AND MAIN: 36t}385 9444 FAX: 36t}3859401 HEALTHIER COMMUNITY FAX: 360379-4487 MRSA infections to help them care for themselves appropriately and prevent/stop transmission of MRSA. The12 page pamphlet from this toolkit is printed and in your public health resource binder. • I hope that this information is useful to you in your daily practice of medicine. Feel free to contact me if you have any additional questions or concerns. Sincerely, Scott Lindquist MD MPH Health Officer, Kitsap County Health District Deputy Health Officer, Clallam and Jefferson Counties • COMMUNITY HEALTH TH ENVIRONMENTAL HEALTH PUBLIC HEAL DEVELOPMENTAL DISABILITIES ALt�lt1YS�'vORKINGF RASAFETH WATER QUALITY MAIN: 66434HEALTHIER COMMUNITY FAX: 7 FAX 364385-95-940101 3603794487 • Health Advisory: Interim Influenza Antiviral Treatment Guidance, 2008-2009 • December 22, 2008 Three strains of Influenza are likely to circulate this year: Influenza A (H1N1), Influenza A (H3N2), and Influenza B. Of 50 H1N1 viruses tested by CDC to date from 12 states, 98% were resistant to oseltamivir, and all were susceptible to zanamivir, amantadine and rimantadine. H3N2 strains and Influenza B viruses remain susceptible to oseltamivir. The proportion of H1Nlviruses among all influenza strains that will circulate during the 2008-09 season cannot be predicted, and will likely vary over the course of the season and among communities. The following guidelines are offered for consideration by Clinicians utilizing antiviral medications for the treatment of acute influenza infections: • Resistance to antiviral medications highlights the importance of continuing to vaccinate patients throughout the flu season to protect as many individuals from influenza infection and its complications as possible. Influenza activity remains low in Washington State. • Influenza antiviral drug treatment is most important for patients at high risk for severe complications of influenza infection (i.e., patients requiring hospitalization). • Consider use of influenza tests that can distinguish influenza A from influenza B. Patients testing positive for influenza B may be given either oseltamivir or zanamivir (no preference). • • Treatment strategy should take into account that information regarding viral subtype (H1N1 or H3N2) is rarely available in a timely enough manner to guide treatment decisions, and in some cases influenza viral type (A or B) may not be available. o Review local influenza virus surveillance data weekly during influenza season to determine which types and subtypes of influenza A virus are currently circulating. o State influenza surveillance data and links to regional and national data are available at: http://www.doh.wa.gov/EHSPHL/Epidemiology/CD/fluupdate.htm o Oseltamivir should be used alone only if recent local surveillance data indicates that circulating viruses are likely to be influenza A (H3N2) or influenza B viruses. • If a patient tests positive for influenza A or tests negative for influenza by rapid antigen test but for whom antiviral treatment is desired based on influenza symptoms during a period of high influenza activity locally, zanamivir should be considered if treatment is indicated. o Combination treatment with oseltamivir and rimantadine is an acceptable alternative, and might be necessary for patients that cannot receive zanamivir, (e.g., patient is <7 years old, has chronic underlying airways disease, or cannot use the zanamivir inhalation device), or if zanamivir is unavailable. Amantadine can be substituted for rimantadine if rimantadine is unavailable. • • For persons with complicated influenza requiring hospitalization, please consult with an infectious disease specialist for treatment recommendations. • • Review the complete interim guidance from CDC on influenza drug treatment available at http://www.cdc.gov/flu/professionals/antivirals/index.htm. TABLE Interim recommendations for the selection of antiviral treatment using laboratory test results and viral surveillance data, United States,2008-09 seasons This table is an attachment to HAN issued 12/19/2008,"CDC Issues Interim Recommendations for the Use of Influenza Antiviral Medications in the Setting of Oseltamivir Resistance among Circulating Influenza A(H1N1)Viruses,2008-09 Influenza Season" Rapid antigen Predominant Preferred Alternative(combination antiviral treatment) or other virus(es) in laboratory test community medication(s) Not done or 1-11N1 or Zanamivir Oseltamivir+Rimantadine* negative, but clinical suspicion unknown for influenza Not done or H3N2 or B Oseltamivir or None negative,but clinical suspicion Zanamivir for influenza Positive A H1N1 or Zanamivir Oseltamivir+Rimantadine* unknown • Positive A H3N2 or B Oseltamivir or None Zanamivir Positive B Any Oseltamivir or None Zanamivir Positive A+B** H1N1 or Zanamivir Oseltamivir+Rimantadine* unknown Positive A+B** H3N2 or B Oseltamivir or None Zanamivir *Amantadine can be substituted for rimantadine but has increased risk of adverse events. Human data are lacking to support the benefits of combination antiviral treatment of influenza; however, these interim recommendations are intended to assist clinicians treating patients who might be infected with oseltamivir-resistant influenza A(HIN1)virus. **Positive A+B indicates a rapid antigen test that cannot distinguish between influenza and influenza B viruses • 4 Board of Health 0 C Business .agenda Item # XV., 2 Public HeaCtfi Impacts of • 3-feavy Rains and Flooding January 15, 2009 • 6 , , , „,...,.-,. ,. .,,,,„, .,,,,, , ,,,t,t:_,..„ ,,,, ,,v , 4,;,frili;1,1.: V /1 .4 , 1 ' g " t . 4,4.114158 * 4 , HOME IHEALTH 11 ENVIRONMENT II INFORMATION II NEWS I ABOUT JCPH 11 SEARCH I Home > News 4', � Y� Heavy Rains MayBringHealth Risks Onsite Sewage Systems and Drinking Water Wells also Vulnerable Jefferson County, WA, January 7, 2009 - Due to the heavy rains predicted over the next several days, Jefferson County Public Health (JCPH) is advising the public to be aware of the following health risks associated with excessive surface runoff, flooding or sewage spills. • Flood waters carry disease and other contaminants, requiring precautions to prevent illness. • If your drinking water well is flooded, assume that the water in your home is contaminated. • Onsite sewage systems may not function and/or are vulnerable to failure during flood conditions requiring measures to protect these systems. • Shellfish should not be harvested during periods of heavy rain due to contaminated stormwater runoff that may pollute marine waters and shellfish beds. • If a drinking water well is flooded, Jefferson County Public Health advises to use bottled water that has been stored less than six months in tightly sealed containers, or take preventive measures to sanitize the potentially contaminated water. Plan for one gallon of water per person, per day. • If contaminated 'water is clear, boil it for one minute to kill disease-causing bacteria and parasites, or add 1/8 teaspoon household bleach per gallon of water. Let it sit for 1/2 hour. • If contaminated water is cloudy, pour it through a coffee filter, paper towel, or cheesecloth, and then boil it for one minute. If you can't boil it, filter it and add Ya teaspoon of bleach per gallon. Let it sit for one hour. Wells may require disinfection if flooded. Contact Jefferson County Public Health at (360) 385- 9444 for instructions. Onsite sewage systems can not operate properly if soil in the drainfield area becomes saturated. If your drainfield is very wet or under water, reduce your indoor water use as mush as possible in order to prevent catastrophic failure of the system. When soil has dried sufficiently, it's probably safe to resume normal water use. During extreme wet weather, property owners can follow several simple measures to protect their sewage systems and their property investments including: •009 :PH :: Working for a safer and healthier Jefferson I News I Heavy Rains May Bring Health Risks Page 2 of • Minimize water use in the home. Stay well below your sewage system's maximum volume capacity, normally 120 gallons of water use per bedroom per day. • Spread water use throughout the day and week to even out water flow to your drainfield. Don't flood your system with multiple uses all at once or all in one day. One example is to shower in the morning,wash clothes midday, wash dishes in the evening, and limit clothes washing to one or two loads per day. • Identify and repair all leaky plumbing fixtures. A running toilet or a leaky faucet can discharge many gallons of extra water each day to your drainfield. • Identify and repair all leaky sewage system tanks, risers, etc. • Divert all surface waters and downspouts away from your sewage system. Because floodwaters carry disease and other contaminants, if the home is flooded, JCPH advises people to wash their hands with soap and disinfected water before preparing or eating food, after using the toilet, or handling contaminated items. Discard all food that has come in contact with floodwater. Canned food is all right, but disinfect the can before opening. If the power has gone out, keep food safe by using food that spoils rapidly first. Most foodborne diseases are caused by bacteria in raw or undercooked foods of animal origin such as meat, milk, eggs, or fish. Keep refrigerator and freezer doors closed to conserve cold air or keep food cold with ice or dry ice. Additional information is available online at http://www.jeffersoncountypublichealth.org/, or by calling Jefferson County Public Health at (360) 385-9444. ### Back • Jefferson County Public Health 615 Sheridan Street-Port Townsend, WA 98368 360.385.9400 I infol)ieffersoncountypublichealth.org Jefferson County Home Page Web Site by Lineangle Internet Solultions • i /8/2009 i Board of Health Old Business .agenda Item # XV., 4 • Thank you Letters January 15, 2009 • co„, JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org January 7, 2008 Twae Ji, Inc. Chimacum Chevron 5343 Crane Avenue E. Port Orchard, WA 98366 Dear Ms. Twae, Once again we are touched by your generosity and want to thank you for your recent donation of$500 to Jefferson County Public Health. Once again we will reinvest these dollars in the community by buying more teaching aids for mothers and young families in South County and the Tri-Area. Your continued support of Public Health and people in our county is very much appreciated and heart-warming! • Sincerely, Gam_ Jen Baldwin, Director Jefferson County Public Health cc:Jefferson County Board of Health COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH • DEVELOPMENTAL DISABILITIES ALNJAYS�°JORK�Nu`ORASFERHN MAIN:364385 9400 WATER QUALITYMAIN:364385-9444 FAX: 364385-9401 HEALTHIER COMMUNITY FAX:364379-4487 „$ON cF r 3. 18';'4 74ankVou PUBLIC NEALTH ALWAYS WORKING FOR A SAFER AND HEALTHIER COMMUNITY Dear Anne, • Once again we want to thank the members of the Port Ludlow yacht Club for their thoughtful-donation to the Jefferson County Breast and Cervical.3-tealth Program. The continued support of this program has great mean- ing for the well-being and good health of women in our community. we truly appreciate receiving this third donation that comes from the proceeds of your wonderful cookbook. Thank you again! Sincerely, Jean Baldwin, Director Jefferson County Public Health i • Board of 3-leaCt/i .mew Business .Agenda Item #T., 1 PCiarmaceuticaCs, PersonaC Care • Products, and'Water Quality January 15, 20199 • JEFFERSON COUNTY PUBLIC HEALTH .4SX7t 1 615 Sheridan Street • Port Townsend •Washington • 98368 hf3 '`. www.jeffersoncountypublichealth.org • January 8, 2009 Re: WRIA 16 Newsletter To: Board of Health The watersheds of Water Resource Inventory Area (WRIA) 16 are located in Jefferson and Mason Counties and include the Dosewallips, Duckabush, Hamma Hamma, and Skokomish Rivers as well as smaller basins along the west and south shores of Hood Canal. The WRIA 16 Planning Unit began watershed planning in 1999 through the Watershed Management Act (RCW 90.82) to help ensure adequate water clean water for people and fish. Jefferson County produces the WRIA 16 newsletter, Rivers for Life, two to four times per year by agreement with Mason County and the WRIA 16 Planning Unit to inform • watershed residents about the planning process and issues facing the watershed. We are happy to provide you with the current issue and hope you will particularly enjoy the article about our water quality sampling efforts on Hood Canal. The newsletter also contains information regarding a planned investigation into the effectiveness of municipal water treatment facilities in removing pharmaceutical compounds. Community guidance on the disposal of unwanted medications at home was developed with the assistance of Jean Baldwin and Drs. Tom Locke and Diana Yu (of Mason County). Past newsletters are available on the WRIA 16 website at: www.ecy.wa.gov/apps/watersheds/planning/16.html. 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N U _ w "' W I Y M CN - 1 -\-, --)\-"---\,1 ('' 0e cu •LI �� r .117° �� G � Ce = ° „cr: :4:c'M PM € co o 6w 0 1 � e o o v-, hl -a O —4 ,A t 0 w L =r i p� N O r i7 Y w 'h 0 u7 +fir � C^7 0. � c x /f r� 'I _ ffil "�,'yam n, a ° CO • / ...-z- 0 it, Q r The Facts About Childhood Vaccines A • Vaccine Education Center at • The Children's Hospital ofPhiladel a' Volunie 5 Spring20( �' phi p Q.How can parents sort out conflicting information • to prevent infections that are common in other parts of the world about vaccines? Although some diseases have been completely eliminated(polio) or virtually eliminated(diphtheria)from this country,they still occur A.Decisions about vaccine safety must be based on well-controlled commonly in other parts of the world.Children are commonly scientific studies. paralyzed by polio in India or killed by diphtheria in Russia.Because there is a high rate of international travel,outbreaks of these diseases Parents are often confronted with"scientific"information found on are only a plane ride away. television,on the Internet,in magazines and in books that conflicts Atkinson W,et al.Epidemiology and Prevention afVaccine-Preventable Diseases. with information provided by healthcare professionals.But few parents 9th Edition.Centers for Disease Control and Prevention,U.S.Dept.of Health have the background in microbiology,immunology,epidemiology and Human Services,2006. and statistics to separate good scientific studies from poor studies. Parents and physicians benefit from the expert guidance of specialists .\re vaccities safe? with experience and training in these disciplines. Committees of these experts are composed of scientists,clinicians A.Because vaccines are given to people and other caregivers who are as passionately devoted to our children's who are not sick,they are held to the highest health as they are to their own children's health.They serve the Centers standards of safety.As a result,they are among for Disease Control and Prevention(www.cdc.gov/nip),the American the safest things we put into our bodies. Academy of Pediatrics(www.aap.org)and the Infectious Diseases How does one define the word safe?If safe is Society of America(www.immunizationinfo.org),among other , defined as"free from any negative effects,"then groups.These organizations provide excellent information to parents : vaccines aren't 100 percent safe.All vaccines have and healthcare professionals through their Web sites.Their task is to " possible side effects.Most side effects are mild, determine whether scientific studies are carefully performed,published such as fever,or tenderness and swelling where the shot is given. in reputable journals and,most importantly,reproducible.Information But some side effects from vaccines can be severe.For example,the that fails to meet these standards is viewed as unreliable. pertussis vaccine is a very rare cause of persistent inconsolable crying, When it comes to issues of vaccine safety,these groups have served high fever or seizures with fever.Although these reactions do not us well.They were the first to figure out that intestinal blockage was cause permanent harm to the child,they can be quite frightening. a rare consequence of the fust rotavirus vaccine,and the vaccine was If vaccines cause side effects,wouldn't it be"safer"to just avoid . quickly discontinued.And they recommended a change from the oral them?Unfortunately,choosing to avoid vaccines is not a risk-free polio vaccine,which was a rare cause of paralysis,to the polio shot choice—it is a choice to take a different and much more serious when it was clear that the risks of the oral polio vaccine outweighed risk.Discontinuing the pertussis vaccine in countries like Japan and its benefits. England led to a tenfold increase in hospitalizations and deaths from These groups have also investigated possible relationships between pertussis.Recently,a decline in the number of children receiving vaccines and asthma,diabetes,multiple sclerosis,SIDS and autism. measles vaccine in the United Kingdom led to an increase in measles No studies have reliably established a causal link between vaccines hospitalizations and deaths. and these diseases—if they did,the questioned vaccines would be When you consider the risk of vaccines and the risk of diseases,vaccines withdrawn from use. are the safer choice. Plotkin,S,et al. Vaccines.4th Edition,W.B.Saunders and Co.,2004. If the diseases that vaccines prevent are now rare, Why should my child still get vaccines? Q.Do children get too many shots? A A.Although several of the diseases that vaccines A.Newborns commonly manage many challenges to their immune prevent have been dramatically reduced or system at the same time. eliminated,vaccines are still necessary: Because some children could receive as many as 25 shots by the time • to prevent common infections. they are 2 years old and as many as five shots in a single visit to the Some diseases are so common in this country doctor,many parents wonder whether it is safe to give children so that a choice not to get a vaccine is a choice to many vaccines. '1 get infected.For example,choosing not to get Although the mother's womb is free from bacteria and viruses, the pertussis(whooping cough)or varicella newborns immediately face a host of different challenges to their (chickenpox)vaccines is a choice to risk serious and occasionally immune systems.From the moment of birth,thousands of different fatal infections. bacteria start to live on the surface of the intestines.By quickly • to prevent infections that could easily reemerge. making immune responses to these bacteria,babies keep them from Some diseases in this country continue to occur at very low levels invading the bloodstream and causing serious diseases. (for example,measles,mumps and Haemophilus influenzae type b, In fact,babies are capable of responding to millions of different or Hib).If immunization rates in our schools or communities are low, viruses and bacteria because they have billions of immunologic cells outbreaks of these diseases are likely to occur.This is exactly what circulating in their bodies.Therefore,vaccines given in the first two happened in the late 1980s and early 1990s when thousands of children years of life are a raindrop in the ocean of what an infant's immune were hospitalized with measles and more than 120 died.Children system successfully encounters and manages every day. were much more likely to catch measles if they weren't vaccinated. Offit PA,et al.Addressing parents'concerns:Do vaccines weaken or overwhelm the infant's immune system?Pediatrics 109:124-129,2002. • continued ► For the latest information on all vaccines, visit our Web site at vaccine.chop•edu. Does the MMR vaccine cause autism? Q.Does thimerosal,a mercury-containing preservative, cause autism? A.Carefully performed studies clearly disprove the notion that autism is caused by the MMR vaccine. A.Thimerosal,an ethylmercury-containing Because the signs of autism may appear in the second year of life, III preservative,has now been removed from all at around the same time children receive certain vaccines(such as routinely recommended vaccines with the MMR),and because the cause of autism is unknown,some parents exception of the influenza vaccine. wonder whether vaccines might be at fault. Five studies performed on three continents clearly The vast weight of medical and scientific evidence now strongly show that the incidence of autism was the same in refutes the notion that MMR causes autism.Studies of hundreds children who received vaccines that contained of thousands of children in the United States,the United Kingdom thimerosal as in those who received vaccines that and Denmark found that children with autism were not more likely didn't contain thimerosal.The Institute of Medicine,an independent to have received the MMR vaccine,or to have received the MMR research organization within the National Academy of Sciences, vaccine recently,than other children. reviewed these studies and concluded that thimerosal doesn't cause autism.Perhaps the best study,published in July 2006,took advantage Four of the 14 studies that found that the MMR vaccine did not of a natural experiment that occurred in Montreal between 1987 and cause autism are listed below: 1998 when the quantity of thimerosal in vaccines varied.Between Taylor,B,et al.Autism and measles,mumps,and rubella vaccine:no epidemiologic 1987 and 1991,vaccinated babies received 125 micrograms of evidence for a causal association.Lancet 351:2026-2029,1999. thimerosal,between 1992 and 1995 they received 225 micrograms, Dales L,et al.Time trends in autism and in MMR immunization coverage in and after 1996 they received 0 micrograms.If thimerosal caused autism, California.JAMA 285:1183-1185,2001. the incidence of autism should have been much higher in children Kaye JA,et al.Measles,mumps,and rubella vaccine and incidence of autism recorded born between 1992 and 1995 than in those born after 1995.In fact, by general practitioners:a time-trend analysis.Brit Med J322:460-463,2001. Madsen KM,et al.A population-based study of measles,mumps,and rubella the opposite was true;the incidence of autism was much higher in vaccination and autism.NEng!JMed 347:1477-1482,2002. babies born after 1995 than in those born before 1995.Similarly, Denmark,a country that abandoned thimerosal as a preservative in 1991,actually saw an increase in autism several years later.This increase Q. Do vaccines cause chronic diseases like diabetes, in autism rates was most likely due to a broadening of the definition multiple sclerosis,asthma or allergies? of the disease to include Asperger's syndrome,autistic spectrum disorder A.A wealth of evidence now confirms the and pervasive developmental delay. fact that vaccines do not cause allergic or Fombonne E,et al.Pervasive developmental disorders in Montreal,Quebec,Canada: gr prevalence and links with immunization,Pediatrics 118:139-150,2006. autoimmune diseases. Hviid A,et al.Association between thimerosal-containing vaccine and autism. Most people get vaccines.Therefore,people with JAMA 290:1763-1766,2003. n chronic diseases like diabetes,multiple sclerosis, Andrews N,et at.Thimerosal exposure in infants and developmental disorders: asthma or allergies are likelyto receive vaccines. a retrospective cohort study in the United Kingdom does not support a causal s" g association.Pdiatrics 114:584-591,2004. , '; Y Some of these people will receive a vaccine just to the first symptoms of their disease.The Herron J.Thimerosal exposure in infants and developmental disorders:a prospective _. priorsy P cohort study in the United Kingdom does not supporta causal association.Pediatrics question is,"How can you tell whether a vaccine caused a disease?" 114:577-583,2004. The best way to answer this question is to perform a scientific study. Verstraeten T,et at Safety of thimerosal-containing vaccines:a two-phased study of computerized health maintenance organization databases.Pediatrics 112:1039- For example,some people who smoke a lot of cigarettes get lung 1048,2003. • cancer.To determine whether cigarette smoking caused lung cancer, studies compared the incidence of lung cancer in people who Do vaccines contain additives? smoked cigarettes to people who didn't smoke.The best studies matched these two groups of people with regard to age,general A.Many vaccines contain trace quantities of antibiotics or stabilizers. health,medications and so on.By matching these groups researchers made sure that the only difference between them was cigarette smoking. Antibiotics are used during the manufacture of vaccines to prevent The result was clear—cigarette smoking caused lung cancer. inadvertent contamination with bacteria or fungi.Trace quantities Similarly, people who use cellphonesget brain cancer. of antibiotics are present in some vaccines.However,the antibiotics Y P P contained in vaccines(neomycin,streptomycin or polymyxin B)are To determine whether cell phones caused brain cancer,the incidence not those commonly given to children.Therefore,children with allergies of brain cancer in people who used cell phones was compared to to antibiotics such as penicillin,amoxicillin,sulfa,or cephalosporins people who didn't use cell phones.Again these groups were matched can still get vaccines. to make sure that the only difference between them was cell phone use.That result was also clear—cell phones didn't cause brain cancer. Gelatin is used to stabilize live viral vaccines and is also contained in many food products.People with known allergies to gelatin contained By doing matched studies of people who did or did not receive in foods may have severe allergic reactions to the gelatin contained in vaccines,we now know that vaccines don't cause diabetes,multiple vaccines.However,this reaction is extremely rare. sclerosis,allergies or asthma.A publication that reviewed 93 studies Offit,PA,Jew RK.Addressing parents'concerns:Do vaccines contain harmful examining the relationship between vaccines and chronic diseases is preservatives,adjuvants,additives,or residuals?Pediatrics 112:1394-1401,2003. listed below: American Academy of Pediatrics.In Pickering LK,ed.Red Book:2003 Report of the Offit,PA and Hackett,CJ.Addressing parents'concerns:Do vaccines cause allergic Committee on Infectious Diseases.26th ed.Elk Grove Village,IL or autoimmune diseases?Pediatrics 111:653-659,2003. This information is provided by the Vaccine Education Center at The Children'sVaccine Education Center at Hospital of Philadelphia.The Center is an educational resource for parents and Iv healthcare professionals and is composed of scientists,physicians,mothers and fathers The Children's Hospital of Philadelphia who are devoted to the study and prevention of infectious diseases.The Center is funded by endowed chairs from The Children's Hospital of Philadelphia and Kohl's vaccine,chop.edu . Department Stores.The Vaccine Education Center does not receive support from • pharmaceutical companies. CH Some of this material was excerpted from the book, Vaccines:What You Should Know, The Children's Hospital ofPhiladelphia" co-authored by Paul A.Offit,M.D.,and Louis M.Bell,M.D. Hope lives here. The Children's Hospital of Philadelphia.the nations first pediatric hospital, is a world leader in patient care and pioneering research. • Board of 3-fealth Netiv Business .agenda Item #17., 3 Flow Sheet - Boards & Committees • Related to Substance Abuse treatment and Prevention January 15, 2009 1 ;" / @\ = co C.) —. *) � c 0� , _ F . K • / � \ / ƒ \ 0 , - A \ / c > aTo co \ cco 2 E EE 2g k E %/ ) ° . 0 1� \ c it 8 .- / ( | \ § } 1 ) / EE — «oc.k mo ° } \& . \\ & / §/\ cT3 to w — E®f± } RI 0,0 I- o = f 'fL _ � o E§co ) §° 0 . _ \ a/ �\ o 2 • . ;- »_ /0 / E c £ CO » 3 ( 2a a) � � \ s £_ _ • 7 )� co � . E $ k E ° )$ ;o 2 � $ / ®§ §G ec E _ / \ k\ � _ . — ] }»y {® . CL) P A c 2 / » o f : ' m k S ® �� . e § °^ ^\' 0 co ors \ — \ Z. � \o CO \ /] o ± $_£ 0 2 a e - 1\ �/ a & &c0_ /< owox \ CO 0 ` \ \ < 0�\ y�� �\ �ca\ o . ) = e = 7 < -, f �� \ƒ `3s) \ \ m E m / . o § co 0 _ 2 / cu e I. ] 1 / o ` — < -3 ' ® ® 7ƒ={ . S / �f® f � 4 m5f 2f o< // k ' #\\A \f /\ y/ Cl) ° = e &A s -< Q o ; j < 2 § co 0 oq R �/ )/k ; ) k j § OE k 2 f / %/ 7 < Board of Health Netiv Business .agenda Item #`V., 5 3fealth Care Community Discussion forums - • Jefferson County Input January 15, 2009 • Hi. QUESTIONS • 1, Briefly,from your own experience,what do you perceive is the biggest problem in the health system? 2. How do you choose a doctor or hospital? What are your sources of information? How should public policy promote quality health care providers? 3. Have you or your family members ever experienced difficulty paying medical bills? What do you think policy makers can do to address this problem? 4. In addition to employer-based coverage,would you like the option to purchase a private plan through an insurance-exchange or a public plan like Medicare? 5. Do you know how much you or your employer pays for health insurance? What should an employer's role be in a reformed health care system? 6. Below are examples of the types of preventive services Americans should receive. Have you gotten the prevention you should have? If not,how can public policy help? 7. How can public policy promote healthier lifestyles? • EXAMPLES OF RECOMMENDED PREVENTIVE SCREENINGS Screening Mammography: • All of the major professional societies that make recommendations about breast cancer screening recommend that women by age 50 and older get a routine annual screening mammography for breast cancer. Many of these societies recommend that women should undergo such screening at age 40.14 • Yet, only 71.8 percent of women age 50-64 and 63.8 percent of women 65 or older received a screening mammogram in 2005.15 Flu Shots: • The Centers for Disease Control and Prevention recommends that all adults over the age of 50 receive an annual vaccine against influenza.16 • Yet,in 2006,only 45.9 percent of adults over the age of 50 received a flu shot!' Cholesterol Screening: • The U.S. Preventive Services Task Force recommends that doctors routinely screen men ages 35 years and older and women ages 45 years and older for high cholesterol.18 • Yet, according to data from 2007, only 74.9 percent of adults in the U.S. had their cholesterol checked within the past five years.19 • 3 PARTICIPANT SURVEY FOR HEALTH CARE COMMUNITY DISCUSSION (Please Give Your Survey To Your Host—Thank You!) • 1. What do you perceive is the biggest problem in the health system? a. Cost of health insurance b. Cost of health care services c. Difficulty finding health insurance due to a pre-existing condition d. Lack of emphasis on prevention e. Quality of health care 2. What do you think is the best way for policy makers to develop a plan to address the health system problems? a. Community meetings like these b. Traditional town hall meetings c. Surveys that solicit ideas on reform d. A White House Health Care Summit e. Congressional hearings on C-SPAN 3. After this discussion,what additional input and information would best help you to continue to participate in this great debate? a. More background information on problems in the health system • b. More information on solutions for health reform c. More stories on how the system affects real people d. More opportunities to discuss the issues • 4 References • Kaiser Family Foundation and Health Research and Educational Trust,"Employer Health Benefits 2008"(Menlo Park, CA),Kaiser Family Foundation(2008),available at 2 C.T.Robertson,R.Egelhof,and M.Hoke,"Get Sick,Get Out:The Medical Causes of Home Foreclosures,"Health Matrix, 18(2008):65-105,available at 3 Len M.Nichols and Sarah Axeen,"Employer Health Costs in a Global Economy:A Competitive Disadvantage for U.S. Firms,"New American Foundation(May 2008). 4 Linda T.Kohn,Janet M.Corrigan,and Molla S.Donaldson,Editors;Committee on Quality of Health Care in America, Institute of Medicine,To Err is Human,Washington,DC:National Academy Press(2000). 5 Elizabeth A.McGlynn et al."The Quality of Health Care Delivered to Adults in the United States,"NEJM 348(26): 2635-2645(June 26,2003). 6 McKinsey&Company,"Accounting for the Cost of Health Care in the United States"(January 2007). 7 Stan Dorn et al.,"Medicaid,SCHIP,and Economic Downturn:Policy Challenges and Policy Responses,"Kaiser Commission on Medicaid and the Uninsured(April 2008), 8 Institute of Medicine,"Care Without Coverage:Too Little,Too Late-Report Brief,"Washington,DC:National Academy Press(2002),available at 9 P.J.Cunningham,L.E.Felland,"Falling Behind:Americans'Access to Medical Care Deteriorates,2003-07,"Center for Studying Health System Change,Tracking Report No. 19(June 2008). 10 Gerard Anderson,Robert Herbert,Timothy Zeffiro,and Nikia Johnson,"Chronic Conditions:Making the Case for Ongoing Care,"Partnership for Solutions,Johns Hopkins and Robert Wood Johnson Foundation(2004). '1 Center for Disease Control and Prevention,"Chronic Disease Overview," 12 Center for Disease Control and Prevention,"Preventing Chronic Diseases:Investing Wisely in Health," 13 Jeanne M.Lambrew,"A Wellness Trust to Prioritize Disease Prevention,"The Hamilton Project,Brookings Institution (2007),available at 14 Agency for Health Care Research and Quality,"Screening for Breast Cancer:US Preventive Services Task Force" (February 2002),available at ;American Academy of Family Physicians, . "Periodic Health Examinations: Summary of AAFP Policy Recommendations&Age Charts,"available at Feig,SA,D'Orsi,CJ,Hendrick,RE,et al.,"American College of Radiology Guidelines for Breast Cancer Screening,"American Journal Roentgenology, 171:29, 1998;Amir Qaseem et al,"Screening Mammography for Women 40 to 49 Years of Age:A Clinical Practice Guideline from the American College of Physicians,"Annals of Internal Medicine(April 2007)Volume 146,Issue 7,Pages 511-515,available at 15 National Center for Health Statistics,"National Health Interview Survey in Health,United States,2007 with Chartbook on Trends in the Health of Americans,"Table 87,available at 16 Centers for Disease Control and Prevention,"2008-09 Influenza Prevention and Control Recommendations,"available at 17 National Center for Health Statistics,"National Health Interview Survey in Health,United States,2007 with Chartbook on Trends in the Health of Americans,"Table 85,available at 18 Agency for Health Care Research and Quality,U.S.Preventive Services Task Force,"Guide to Clinical Preventive Services,"(2008),available at 19 National Center for Chronic Disease Prevention&Health Promotion,`Behavioral Risk Factor Surveillance System: Cholesterol Awareness 2007,"(2007),available at i 5 i xrf 4. ti `!NIT P2'5 Jr, PARTICIPANT GUIDE FOR HEALTH CARE COMMUNITY DISCUSSIONS POLICY BACKGROUND AND KEY QUESTIONS The President-elect believes that every American should have high quality and affordable health care,and to reach this goal,we must modernize our health care system in order to: • Improve health care quality and cut costs; • Expand coverage and access;and • Increase the emphasis on primary care and prevention. As we work to revamp our health care system,we need to hear from you. There is no problem that we cannot solve together—and it is out of our collective wisdom and experience that we will identify potential solutions to the many health care challenges that we face. We need to hear your ideas and your stories so that we can report them to the President-elect. What follows is brief background information to help you start a discussion and a set of key questions. Your answers to them will guide our collective effort to reform the U.S.health system. I. OVERVIEW OF THE PROBLEM The potential of health care in America is enormous and ever expanding. Diseases that once were life- • threatening are now curable;conditions that once were devastating are now treatable. We have the knowledge to extend and improve lives. But,as the stories of those who participated in the recent on-line discussion at testify,our system is flawed and fails to deliver affordable,high-quality health care to all Americans. Our system faces three interrelated problems. First,health care costs are skyrocketing,hurting our families as well as our economy: • Health insurance premiums have doubled in the past 8 years,accompanied by increasing co-pays and deductibles that threaten access to care.' • Large medical bills have contributed to half of bankruptcies and foreclosures? • Rising health care costs place a burden on American businesses,as they try to balance health benefit costs with job growth and competitiveness. American manufacturers are paying more than twice as much on health benefits as most of their foreign competitors(measured in cost per hour).3 • Problems with health care quality and administrative"waste"contribute to these costs: o Medical errors result in as many as 100,000 deaths per year in U.S.hospitals! o On average,American adults received just 55 percent of recommended care for the leading causes of death and disability.5 • The U.S.spent$412 per capita on health care administration and insurance in 2003—nearly 6 times as much as other developed countries.6 • 1 Second,over forty-five million Americans have no health insurance: • Nearly 160 million Americans have job-based insurance,but many are just a pink slip away from joining the ranks of the uninsured. For every 1 percentage point increase in the unemployment rate,over one million people become uninsured.' • Being uninsured leads to delayed care—late diagnoses for cancer when it is harder and more expensive to treat,and preventable complications due to untreated diabetes. It also leads to denied care—a child without health insurance is less likely to receive medical attention for recurrent ear infections or for asthma. Uninsured trauma victims are less likely to be admitted to the hospital and are 37 percent more likely to die of injuries.8 • Even people with coverage are increasingly finding that it is insufficient or simply not there when needed. Nearly one in five Americans either delay care or have unmet needs despite having health insurance.9 Third,our nation's investment in prevention and public health is inadequate,leading to rapid spread of chronic diseases,many of which could be prevented entirely or managed: • One in 3 Americans—or 133 million—have a chronic condition,10 and 5 chronic diseases heart disease, cancer,stroke,chronic obstructive pulmonary disease,and diabetes cause over two-thirds of all deaths." • Approximately 1 in 3 children born today will develop diabetes in their lifetime.12 • Only four cents out of every health care dollar is spent on prevention and public health.13 H.THE PRESIDENT-ELECT'S HEALTH CARE PLAN President-elect Obama presented a framework for health reform to achieve three goals: Modernize the Health Care System to Improve Quality and Reduce Costs: • Invest in a national health information technology system that will allow us to coordinate care,measure • quality,reduce medical errors,and save billions of dollars; • Reward health providers that provide high quality care and coordinated care; • Expand disease management programs and self-management training to help patients; • Lower drug costs by increasing the use of generic drugs in public programs,and taking on drug companies that block cheaper generic medicines from the market; • Require hospitals and providers to collect and report health care cost and quality data. Expand Coverage to All Americans: • Build upon and strengthen employer coverage; • Allow people to keep the coverage that they have and maintain patients' choice of doctor; • Establish a National Health Insurance Exchange that offers a range of private insurance options as well as a new public plan option; • Require insurance companies to cover pre-existing conditions so all Americans regardless of their health status or history can get comprehensive benefits at fair and stable premiums; • Expand Medicaid and SCHIP and provide sliding-scale premium assistance for low-income people. Improve Prevention and Public Health: • Require coverage of clinical preventive services such as tobacco cessation services and cancer screenings,in public programs and private health plans; • Invest in community-based prevention that will lead to healthier schools,worksites,and communities; • Tackle the health and public health workforce shortage and bolster the public health infrastructure. • 2 1 G/ JII G C. ,6 VC, e e --"~ "W J ce,\A..1 Join Jan. 10 discussion a°G on healthcare reform By Phyllis Schultz President-elect Barack Obama has appointed a Transition Health Policy Team(THPT)led by Sen.Tom Daschle.Early in December,this team asked citizens to convene community discussions on healthcare reform between Dec. 15 and Dec. 31 and email reports..At least two such events took place in Jefferson County:one on Dec.20 in Port Townsend,with 30 participants, and one at the Jefferson County Library,with 25. • Stories were told at both events by individuals who have been denied care by their insurance companies, suffered staggering out-of-pocket costs • or"went through hell"to get the care they or their loved ones needed.These stories led to a common recommendation to the THPT that reform must 0 include single-payer insurance/universal coverage on a model similar to Medicare for the elderly or the kind of insurance that senators and represen- t tatives have. 4 The groups also agreed that reform should unhook healthcare from the current employer-based system;one group strongly endorsed"The National Health Insurance Act" (HR676) introduced in 2008 by Congressman John Conyers. Other qualities of reformed healthcare would include"simplified paper- work" and"financial transparency" by providers, and "elimination of cor- porate lobbying" and "removing the profit motive" by medical/healthcare providers—especially by drug companies,non-essential cosmetic surgeries and high-tech medical equipment and insurers. Furthermore, the entire system of payment and provision of services should focus on"wellness,prevention and early screening of disease,health III promotion education and client advocacy" as well as treatment of disease and injury. One group suggested that reform be organized similar to"public utilities," which would include private business enterprises to encourage innovation and cost efficiencies but limit excessive profits and executive "bonuses." Both groups agreed that the current "for-profit" systems are costly, ineffi- ; cient,lack quality controls and end up with de facto"rationing of care"that contribute to our current national financial crisis as well as being unfair and unjust. Participants were well informed;some had experience with other systems, such as Australia's. Some were aware of less costly and more effective sys- tems in Germany,France and Japan. Other themes common to both groups included the need for"integrated care involving multiple and complementary practitioners, such as physicians, dentists, nurse practitioners, nutritionists, mental health providers,rehabilitation therapists and health promotion edu- cators."Increasing the number of primary care and related practitioners was viewed as critical to improving access by offering individual scholarships, grants to professional schools, and incentive programs to ensure access to people in underserved rural and urban areas. Science-based care that focuses on "evidence-base outcomes" by prac- titioners and "cost-benefit analyses" were viewed as essential to improved F' quality of care with the greatest cost savings. fr'. Another"Community Discussion on Health Care Reform" is scheduled this Saturday, Jan. 10 at 10 a.m. at the Quimper Unitarian-Universalist Fellowship,2333 San Juan Ave.It is moderated by Jenifer Taylor.This is an important opportunity to engage with others on this critically important pri- ority of the forthcoming Obama administration.Your opinions and concerns s • will help shape the reform so badly needed by all of us. (Dr. Schultz retired in 2000 from the faculty of the University of Washington School of Nursing, where,she taught health services administra- tion and community health.) here is an opportunity for the BOCC to run for public office.I hope everyone is 0 Board of 3-feaCth .Media Report • January 15, 2009 • Jefferson County Public Health December 2008/January 2009 NEWS ARTICLES 1. "County OKs '09 budget, 13 job cuts," Peninsula Daily News, December 16th, 2008. 2. "'Tis the season for depression; new mental health resource guide helps," Port Townsend Leader, December 17th, 2008. 3. "Jefferson schedules flu clinics throughout month," Peninsula Daily News, December 17th, 2008. 4. "Get a flu shot for the holidays," Port Townsend Leader, December 24th, 2008. 5. "Septic files now available online in Jefferson County," Peninsula Daily News, December 25th, 2008. 6. "Changes to conservation futures announced, meetings in January," Port Townsend Leader, December 31, 2008. 7. "Public gains access to septic records," Port Townsend Leader, December 31, 2008. 8. "County seeks more funding," Peninsula Daily News, January 2, 2009. 9. "Still time to get flu shots," Peninsula Daily News, January 7, 2009. 10. "Join Jan. 10 discussion on healthcare reform," Port Townsend Leader, January 7th 2009. 11. "Colon Health Program Update,"WA State Breast and Cervical Health Program, Winter 2008 Newsletter. • 12. "Recommendations of the National Association of County and City Health Officials to the Presidential Transition Team Concerning Health Policy and Health Reform Goals," NACCHO, December 2008. 13. "Free Adult Hepatitis A & B Vaccine and Free Adult Hepatitis C Testing," JCPH Flyer. • .. Count oKs County The commissioners also adopted 3 percent raises for salaried exempt management and budget, professional l countyarls. staff and for elected department heads. • "It is extremely important to have a sal- ary schedule that continues to attract good 13 job � employees,"said Commissioner John Austin, D-Port Ludlow. Overall, 53.7 percent of the budget is going to staff salaries and benefits. Some managers see Morley said the budget "was not done through the dictates of this office but was 3 percent pay raises the result of collaboration with county department heads and staff." BT JEFF CHEW Community development PENINSULA DAILY NEWS Actual county layoffs were limited to the PORT TOWNSEND—With little discus- Department of Community Development, sion Monday,Jefferson County commission- where six positions were recently eliminated ers unanimously approved a $48 million because building permits and the fees that 2009 budget that eliminates 13 jobs—six of accompany them plummeted. them layoffs—to help offset revenues lost in That department's remaining staffers a soured economy. were cut to 36-hour work weeks,including Al "This does bring expenditures and reve- Scalf,community development director. Hues more in balance with each other,"said The department's hour reductions amount County Administrator Philip Morley, who to two full-time positions,Morley said. started with the county in late October and TURN TO BoDCET/A6 was thrown cold into a budget bereft of sale andreal estate excise tax and permit.reve- nues. Budget: 43percent staff educti. on CONTINUED FROM Al ing and development review tended to use it or lose it. ', professional services by fees,about$300,000, The banked capacity con- $70,000. A 4.3 percent staff reduc- Morley said for 2009 the cept allows districts to be The sheriff budgeted over- tion• was approved with the banked capacity will amount more fiscally conservative time of $225,000 in salaries budget, leaving the county to about $25.02 a year tax without being penalized. and benefits,which previously with 297.6..full-time-equiva- increase for the average ` had not been done. lent positions. . home. . Budget cuts ■ Other reductions amount The commissioners a month He explained that ever ; Cuts to make budget are; to $229,000 for the Depart- ago declared a budget.emer- year the commissioners`have g ment of Community Develop- gency in a 2-1 vote,with Com- chosen not to take banked ■ The Assessor's Office has ment, $151,000 for Public missioner David Sullivan capacity has meant a agreed to postpone vehicle Health, facilities reductions opposed. $700,000-a-year savings to replacement for a year. amounting to $55,000, WSU The commissioners autho- taxpayers. I The Auditor's Office Cooperative Extension reduc- rized a hiring freeze and voted Banked capacity can be re- agreed to reduce a staff quer- tions of $24,000 and Parks ter full-time equivalent posi- and Recreation cuts of to use the county's banked created once the economy capacity (delayed tax provi- recovers,he said. tion and reduce printing costs $4,350. 'sion)for the general fund—a Beginning in 1986,the Leg by$25,000. ■ WSU Cooperative Exten- slight tax increase—leaving islature allowed local govern- ■ District Court has sion reduced 11/2 full-time unused banked capacity for ments to levy less than the reduced salaries and benefits positions in staffing and other the road fund and conserve- Maximum,:increase in; prop ' `by $25,000 by reclassifying professional services, and tion futures tax levy. ' arty taxes,allowed under law 'department positions. Public Health reduced 2'/2 That infused$473,171 in without losing the ability to ■ Juvenile Services full-time-equivalent positions. additional revenue. levy higher taxes later,if nec- reduced a half full-time pro- Facilities management A total of $561,000 has essary bation counselor position,say- reduced one full-time been cut from the budget. This provision encouraged ing $35,000, which will be g employee, eliminating its taxing districts to levy only reviewed at mid-year. manager position, but Jeff- Tax decline what they needed rather than_ ■ The Prosecuting Attor- Comm 9-1-1 added two full the maximum allowable., ney's Office reduced one full time employees. The county,administrator ° Prior.to'•that, taxing'dis'`",time office manager position, reported a county real estate tricts that,took less than the ;which remains unfilled, say- excise tax decline of about 50 maximumatthat point 6 peri;:ing$52,000. Port Townsend-Jefferson County Edi- percent since 2006 — from cent annually, permanently IN The Sheriff's Office tor Jeff Chew can be reached at 360- $1.4 million to$650,000 and a lost some of their :levying' reduced a deputy position, 385-2335 or at jeffchew®peninsula 25 percent decrease in build- capacity. Therefore, districts saying $92,000, and reduced daitynews.com. • 41) ?N/v /02A/o,?. . . Tis the season for depression; new ... mental health resourcejuide helps By PatrickJ.Sulihran who compiled these local statistics while managing a ,-1,--;,,,--,,1%...,^7. r z t;� 407.: '' • Leader Staff Writer grant that led to the Mental Health Recovery Resource Guide 2008-09. Its:;not the holidays} ` _" Even under so-called"good economic times,"the Economic realities of these uncertain times weigh . It's not truetham tore ii1ddes occur around„_the number of suicides in Jefferson County could surprise heavily on the mentally ill,who might lack a solid job a)rs„holidresect h i is shove HeatIe Taradu°,who 5` anyone. or family support system.This new 86-page resource illedidieproleitfocrt t*tM1JeeitiiiiiCountyMental,'f In Jefferson County,from 1997 to 2006 there were. guide is intended to help people take positive action. ,_Health Recovery Guide. lcr seven murders and 40 suicides.In the same 10 years "If you or a loved one suffers from depression or Suicide numbers climb In the spring,wfien tM`a- almost 150 people here attempted suicide and were mental illness,help is available,”Taracka said."Life ' `weather typically gets'nicer and people still find hospitalized for injuries. can be different You can be happy again.Please seek themselves feeling depressed.F i s Others attempted suicide and were not injured help through the numerous resources we have avail- „,,Thehendays an very wry hard,'she said'You” enoughto be hospitalized. An untold number of able to us in this area." ' P ra lot of depratulon havaround the holidays,,but It people here considered suicide as an option. The free guide is specifically directed at families, doesn't luaus,suicide rates.' Suicide is often a direct result of untreated mental individuals and agencies trying to help those with ...LL t;,; .r . illness and depression,according to Heather Taracka, See HEALTH,Page 17 Health: is treatable • Contin d from mental illness, but "We're very pleased with In Jefferson from 1997 to mental illness, but it's also a the reaction we've gotten from County, ° ;e complete overall resource dime- every professional we've given 2006 there were seven_murders and a I 1 '2,1 I . tory. It has names,phone num- it to,"Taracka said. z�x- , bens,addresses,directions,hours The guide cover image is that 40 suicides. In the same 10 years f ° t and program descriptions under of a tree of hope, printed oni. 'thesecategories:Housing,Food a bright orange cover. Copies almost 150 people here attemptedreT:A:?'-t).:--°191'1;,.."'"."::";::?.:;!:r!it"Ex and Basic Needs,Employment, are available for free and canEducation and Job Training; be picked up at-various lora- suicide, did not succeed, and were «, t t Mental Health Support Services, tions,including Jefferson Mental 2� R° , r and Health Insurance, Medical Health,884 West Park Ave.,and hospitalized for injuries. C294*. .k., , Care and Dental Care. OIyCAP, 803 West Park Ave., r , both in Port Townsend behind the s Resource Guide �r �� ,� Goodwill store,and at Jefferson bh A statewide assessment in County Public Health, 615 t- i--,,, atat In ur',es I I r I i ' , ,,, 2006 indicated communication Sheridan St. in Port Townsend. 'Q . ..x ,657# °r' ' gaps in how to find basic resourc- For more information, email O0tR`l ' 'DES ,°'. ��. " ,'y es to address mental illness.It's an Juan iA y ' mhrrg@olympus.net � � �`�" particularly important in rural i,EFFER$ areas, where people might not Finding help a x " '' ' , know how to get help. Many people who suffer from1:1-'' '''..41.' max "".Together, Jefferson County . amental illness are never treat- mi% h�' � F �.y � ��� `� ��.,�,,�.,� �.; Citizens for Health Care Access ed or even diagnosed, Taracka tt 7, Harbor " ' (JCCHCA)and the local NAMI reported.And most people wnora, "i si ,, (National Alliance on Mental are in treatment are discreet and �10 '. a .. 'r Illness) affiliate wrote and secretive,she said.Fearing rejec- a w ,tr ' - �s Rrlleo received grants totaling $13,367 tion from familyand friends, r ,�` 4 over a two-year period.'The "�'t Y Pe people may hide or deny their__ ' Washington State Mental Health illness. especially vulnerable to mental Recovery rates the individual and society are Transformation Grant was People who are dealing with a illness,though people of any age Taracka said there is good staggering:unnecessary disabil- overseen by the University of mentally ill family member often are susceptible. news:Recovery rates for mental- it unemployment substance Washington School of Medicine. feel embarrassed and shameful According to national esti- ly ill people who sack treatment abuse, homelessness, inappro Taracka began work in June and won't talk with friends about . mates, as many as 45 percent often surpass the success rates of prime incarceration,suicide and 2007,and the guide was printed what they are going through, of homeless people suffer from treatments for Physical illnesses' wasted lives,"she said in October 2008. Only1,000 Taracka noted severe mental illness,accordingRecovery rates include: Jefferson County does have copies are available,and it's not According to NAMI,6 percent to Taracka's research. 'schizophrenia-60 int resources available,and Taracka yet available on any website. of Americans suffer from amen- Suicide is the third leading . bipolar disorder- 80 per- urges people to reach out and tai illness, which in tum affects cause of death for young people cent ask for help.The Mental Health one in five families.Adolescents, age 15 to 24.Evidence suggests .major depression-65 to 70 Recovery Resource Guide is the young adults and the elderly are that about 90 percent of teen sur- percent place to start. cides were committed by some- . addiction treatment - 70 one who suffered from a mental percent illness,Taracka reported Fortunately, in Jefferson More than one-third of diag- County,no teens died from sur- nosed people seek treatment, and then go on to have stable cide during the 2002-2006 time and productive lives, and are • frame in the latest state Health neither violent nor a danger report.About half were ages 20- to themselves or society, she 54, and half ages 55-84. The noted For the two thirds who .most common cause of death: don't seek treatment, "the con- firearms. sequences of mental illness for ,E77 `��GCS /sem/6/r7/�M 0 „ . Jefferson schedules - flu :. . . • chnics throughout month ,. , c , .. : , . , , PENINSULA DAILY NEWS Adult and children vaccines Pneumonia shots are$45. Flu vaccines for' children are available to patients. Clients must be at least 11. and adults are available at Phone 360-385-4848. IIISouth County Medical several clinics in Jefferson • Madrona Hill Urgent Clinic,' 294843 U.S. Highway County. Care, 2500 Sims Way, Port 101, Quilcene, 1:30 p.m. to Children's flu vaccines are Townsend, 9 a.m. to 7 p,m. ' 4:30 p.m.Wednesday. offered at Jefferson County Monday through Friday; 9 Medicare patients should Public Health, 615 Sheridan a.m. to 4 p.m. Saturday; 10 bring Medicare cards. St., Port Townsend, from 1 a.m.to 2 p.m.Sunday. Cost without Medicare is p.m. to 4 p.m. Tuesdays and Vaccines are available for $25 a person. Thursdays. adults and children 4 and Cash or checks will be Appointments are not older. accepted. needed. Flu shots are $25. Private insurance will not The health department has . Medicare will be billed. be billed. limited quantities of the nasal e Olympic Primary Care, Phone 360-765-3111. spray vaccine, FluMist, for 1010 Sheridan St, Port children and adults. Townsend. Flu shots are not available Adult and children vaccines°, at this time. are available to patients. For more information, Phone'360-379-8031. phone 360-385-9400. N Port Townsend Family The children's vaccine is Physicians, 934 Sheridan, also available in Port Towsend;,Port Townsend. through Jefferson Medical & Adult and children vaccines Pediatric Group,834 Sheridan are available to patients. St., 360-382-4848; Olympic Phone 360-385-3500. Primary Care, 1010 Sheridan • Safeway.Pharmacy, 442 St., 360-379-8031; - Port Sims Way, Port Townsend, Townsend Family Physicians, walk-ins from 10 a.m. to 6 934 Sheridan St., 360-385- p.m.Monday through Friday. 3500. No appointments neces- . Vaccines for adults, are sary. available at: • Medicare and Medicaid •Jefferson Medical&Pedi- accepted. atric Group,$34 Sheridan St., Bring insurance cards. Port Townsend. • Flus shots are $30. • • • /2 /,7/? Getflu shot for the holidays Travel and close fam- Children's vaccine Adult clinics Physicians, 934 Sheridan, PT4110 ily gatherings that take place All children and teens in • Jefferson Medical & Adult and children's vaccines during the holiday season can Washington are eligible for the Pediatric Group, 834 Sheridan, available for patients of this clin- provide opportunities for the state-supplied influenza vaccine, PT. Adult and children's vac- ic;call 385-3500. spread of influenza. Jefferson provided by Jefferson County cines available for patients •of •Safeway Pharmacy,442 Sims County Public Health advis- Public Health at walk-in immu- this clinic;call 385-4848. Way, PT. Walk-ins welcome for es that people protect them- nization clinics every Tuesday • Madrona Hill Urgent Care, immunizations from 10 a.m. to 6 selves and their loved ones and Thursday between 1 and 4 2500 Sims Way, PT. Flu vac- p.m.Monday through Friday. No by getting immunized against p.m. No appointment is need- cine available during clinic appointment necessary. Medicare the flu. ed. Adult flu vaccines are not hours: Monday-Friday 9 a.m.-7 and Medicaid accepted. Many Flu season usually peaks in offered at this time. For ques- p.m.,Saturday 9 a.m.-4 p.m. and insurances billed;bring insurance Washington between January tions,call 385-9400. Sunday 10 a.m.-2 p.m. Vaccine card. Flu shots $30. Pneumonia and March, so getting vacci- Children's flu vaccine is available for adults and children shots$45.Clients must be at least nated now provides protection also provided through the three age 4 years and older. Flu shots 11 years old. against the seasonal outbreak. Jefferson Healthcare clinics $25. Medicare billed; all others •South County Medical Clinic, About two weeks are required to in Port Townsend; call for an cash. 294843 Highway 101, Quilcene. develop immunity after getting appointment: Jefferson Medical Olympic Primary Care, 1010 Flu clinics Wednesdays,1:30-4:30 a flu shot, according to nursing &Pediatric Group,834 Sheridan, Sheridan,PT.Adult and children's p.m. Call 765-3111. Medicare staff at Public Health. 382-4848;Olympic Primary Care, vaccines available for patients of patients bring Medicare cards.All Influenza, or the flu, is a 1010 Sheridan, 379-8031; Port this clinic;call 379-8031. others$25,cash or check.Private respiratory infection caused by Townsend Family Physicians, • Port Townsend Family insurance is not billed. a virus. 934 Sheridan,385-3500. • • • /-%7y/67-82 Septic files now available online in Jefferson County PENINSULA DAILY NEWS "as built" drawings, original PORT TOWNSEND — plot plans,soil logs,evaluations to septic sys- . of existing systems,wet season Files terns relatingaee available electrons- evaluations and recorded docu- mems such as easements and cally through Jefferson County restrictive covenants. Environmental Health. Most. files from 1969 to 2005 There are also several files for 2006 to 2008 that are corn- are available online, including plete and on the public health septic applications, sewage dis- Web site. posal permit and conditions, Files that are still active will be added as they are com- pleted. This project, which started last year, was funded by a state grant. • It required scanning more than 10,000 files and entering them into an internal elec- tronic filing system and then moving them to the public access Web site. For instructions on how to access the septic files, click on www.jeffersoncountypublic health.org. • )°,0,4; M, t O ,p 2 . y •5 4 17 5j. O c . ° , 3 v o > ° ' '� ' U a p J n ;1 1.g .c ° § ° °3 � . 'Q ,ye .d e .O I e 0 • .,___ 0 3T d ot "0 5 o 'od �p Op� � p i • Na ° d y aO QJ e O 1 U. 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So when I first health Clinic heard that a new student health clinic was being installed into the PTHS cam- Editor,Leader: pus,I nearly choked on my coffee.How As a student of the Port Townsend would this work? How would this be School District, I am familiar with funded?And why? less-than-stellar situations. Funding is We have a public health facility. For essentially nonexistent, many facilities those who are unaware of its existence, are practically wonders of the ancient it's right by our local QFC branch. It world, and the Mountain View parking serves our community in great ways, and it treats many a high school student. Certain students and adults told me that , we desperately needed to have a health clinic inserted into the high school's Gael Stuart Building.I reminded these individuals of our aforementioned QFC- area clinic,only to hear that it was too far away,all the way across town.Lions and tigers and bears,oh my.I reminded these individuals of the public transportation system that would transport students to the facility. The individuals would then tell me that it would be convenient to have the facility on campus. I reminded these individuals that the room proposed • for the site of the clinic was a very small copy room in a building where all other students could see them check in. The individuals then came to the conclusion that maybe an on-campus health clinic was not the best idea. The notion of an in-school clinic was passed around Chimacum, only to be met with the same confidential- ity concerns found in Port Townsend. Once they consider the idea, students themselves realize the lack of logic in the proposed addition of a student health facility.Also,how would this be paid for?Apparently there was a grant of some kind,a donation from the local hospital.This will not pay for the long- term costs of such a clinic,though. I implore students and adults alike to support our existing public health clinic. With our current clinic having to scale back in tough times,what makes us think we can sustain another clinic? Students may have to ask a friend for a ride up the hill,or use public transportation. Lions and tigers and bears,oh my. • JOHN VON VOLKLI student at PTHS /a1/P/O? Public gains access to septic records Jefferson County Public Health has com- ing systems, wet season evaluations, and ning more than 10,000 files, which were 40 pleted a yearlong project of uploading public recorded documents such as easements and entered into an internal electronic filing documents to its website, jeffersoncounty- restrictive covenants. system and then moved to the public publichealth.org. The project is designed to enhance access website. Environmental Health Division docu- the department's customer service while Most files from 1969 to 2005 are avail- ments now available to the public include increasing staff productivity, explained Jean able online.There are also several files from septic applications, sewage disposal permits Baldwin,Public Health director. 2006 to 2008 that are complete and on the and conditions, as-built drawings, original Started late last year and funded by website. 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Medicare billed, all others cash. reported only sporadic cases of influenza in Call 385-9400. • Olympic Primary Care, 1010 Sheridan, Washington in the past few weeks.Influenza Children's flu vaccine is also provided PT. Adult and children's vaccines available activity is not widespread, so if residents through the three Jefferson Healthcare din- for patients;call 379-8031. have not yet had their flu shots,this is a good ics in Port Townsend; call for appointment: • Port Townsend Family Physicians, 934 time to get vaccinated. Jefferson Medical & Pediatric Group, 834 Sheridan, PT. Adult and children's vaccines According to Jefferson County Public Sheridan,382-4848;Olympic Primary-Care, available for patients; call 385-3500. Health, flu season usually peaks in our area 1010 Sheridan; 379-8031; Port Townsend • Safeway Pharmacy, 442 Sims Way, between January and March, so getting vac-. Family Physicians, 934 Sheridan,385-3500. PT. Walk-ins welcome for immuniza- cinated now provides protection against the tions Monday through Friday 10 a.m.-6 seasonal outbreak. About two weeks are Sources of adult flu vaccine p.m. No appointment necessary, Medicare required to develop immunity after getting • Jefferson Medical & Pediatric Group, and Medicaid accepted, many insurances a flu shot. 834 Sheridan, PT. Adult and children's billed. Bring insurance card. Flu shots $30. All children or teens in Washington are vaccines available for patients; call 385- Pneumonia shots $45. Clients must be at eligible for the state-supplied influenza 4848. least 11 years old. Zostavax shingles vac- vaccine. Both flu shots and limited quanti- 4 Madrona Hill UrgentCare, 2500 Sims cine also available by appointment; call ties of the newer nasal spray vaccine are Way, PT. Flu vaccine available during din- 385-2860. available through local walk-in immuniza- is hours: Monday-Friday 9 a.m.-7 p.m., • South County Medical Clinic, 294843 tion clinics every Tuesday and Thursday Saturday 9 a.m.-4 p.m., Sunday 10 a.m.-2 Highway 101, Quilcene. Adult and chil- between 1 and 4 p.m. at the county health p.m. Vaccine available for adults and chil- dren's vaccines available for patients; call department. No appointment is needed. dren age 4 years and older. Flu shots $25, 765-3111. • • • • PT ear rerspecu ve • • ter Join Jan. 10 discussion on healthcare reform By Phyllis Schultz President-elect Barack Obama has appointed a Transition Health Policy Team(THPT)led by Sen.Tom Daschle.Early in December,this team asked citizens to convene community discussions on healthcare reform between Dec. 15 and Dec. 31 and email reports.At least two such events took place in Jefferson County:one on Dec.20 in Port Townsend,with 30 participants, and one at the Jefferson County Library,with 25. Stories were told at both events by individuals who have been denied care by their insurance companies, suffered staggering out-of-pocket costs or"went through hell"to get the care they or their loved ones needed.These stories led to a common recommendation to the THPT that reform must include single-payer insurance/universal coverage on a model similar to Medicare for the elderly or the kind of insurance that senators and represen- tatives have. • • The groups also agreed that reform should unhook healthcare from the current employer-based system;one group strongly endorsed"The National Health Insurance Act" (HR676) introduced in 2008 by Congressman John Conyers. Other qualities of reformed healthcare would include"simplified paper- work" and "financial transparency" by providers, and "elimination of cor- porate lobbying" and "removing the profit motive" by medical/healthcare providers—especially by drug companies,non-essential cosmetic surgeries and high-tech medical equipment and insurers. Furthermore, the entire system of payment and provision of services . should focus on"wellness,prevention and early screening of disease,health promotion education and client advocacy" as well as treatment of disease and injury. One group suggested that reform be organized similar to"public utilities," which would include private business enterprises to encourage innovation and cost efficiencies but limit excessive profits and executive "bonuses." Both groups agreed that the current "for-profit" systems are costly, ineffi- cient,lack quality controls and end up with de facto"rationing of care"that contribute to our current national financial crisis as well as being unfair and unjust. Participants were well informed;some had experience with other systems, such as Australia's. Some were aware of less costly and more effective sys- tems in Germany,France and Japan. Other themes common to both groups included the need for"integrated care involving multiple and complementary practitioners, such as physicians, dentists, nurse practitioners, nutritionists, mental health providers,rehabilitation therapists and health promotion edu- cators."Increasing the number of primary care and related practitioners was viewed as critical to improving access by offering individual scholarships, grants to professional schools, and incentive programs to ensure access to people in underserved rural and urban areas. Science-based care that focuses on "evidence-base outcomes" by prac- titioners and "cost-benefit analyses" were viewed as essential to improved • quality of care with the greatest cost savings. Another"Community Discussion on Health Care Reform" is scheduled this Saturday, Jan. 10 at 10 a.m. at-the Quimper Unitarian-Universalist Fellowship,2333 San Juan Ave.It is moderated by Jenifer Taylor.This is an • important opportunity to engage with others on this critically important pri- ority of the forthcoming Obama administration.Your opinions and concerns will help shape the reform so badly needed by all of us. (Dr. Schultz retired in 2000 from the faculty of the University of 3' Washington School of Nursing, where she taught health services administra- tion and community health) Volume 6,Issue 3 Nogg e Cost Savings s many of you have heard, King County faced an The State of Washington's Department of Health de- over $93 million 2009 budget deficit. Last month 1 ' tided to cut the new state funds for the Washington was announced that King County Administration, •Colon Health Program. Our current Colon Health Pro- working with 15 unions, approved a furlough plan', gram operating in King, Clallam and Jefferson Counties that will save $10.1 million next year. To help ad is funded by the CDC and will continue through 2009 dress the County's 2009 budget shortfall, all King:!'' when the grant ends. County employees, with the exception of certain At this time it is difficult to guess whether the State designated staff(such as public safety employees WCHP funds will be replaced, and if they are, when. and those who serve in 24x7 operations), are re= We are working with our many partners to address this quired to take ten unpaid furlough days in 2009. cut including the American Cancer Society and our Executive Sims expressed the following, "Without Public Health management. Restoring the program is these furloughs we would be faced with cutting anry a priority for Public Health and our goal is to have no other $10.1 million in essential services resulting in'. break in services after August 2009 when the federal more layoffs."The proposed furlough days fall nett CDC grant ends. to existing 2009 holidays or weekends that tend to`. Tentatively we have identified internal funds to con- be the slowest days in the county with the fewest tinue WCHP services through December 2009 and phone calls and requests for service. The agreedt4A these funds can be used to screen clients with symp- furlough dates are: toms, so that policy stands in 2009. However this Friday,Jan. 2, 2009 Friday,Feb. 13, 2009 funding is not a reliable source as a long term solution Friday,April 10, 2009 Friday, May 22, 2009 beyond 2009. We will continue to update you when Friday,June 19, 2009 Monday,July 6, 2009 we have more information. Friday, Sept. 4, 2009 Monday,Oct. 12, 2009 If you have any ideas for maintaining or creating new Wed., Nov. 25, 2009 Thurs., Dec. 24, 2009 funding, please call Ellen Phillips-Angeles Most King County buildings will be closed, as add1t tional savings on these furlough days. Please plan you have anyquestions, please accordingly. If ask:' anyone in our office. S m e ' e eZOFtWicKriiii r 4014 11 . r � t(61.161,05'-',4.1,y-. � �' � � Anon • Vegetable Oil Spray pink in the center, stirring constantly and breaking up • 6 ounces low-fat bulk break- -'` any large pieces. fast sausage or bulk chicken/ Stir in basil and garlic. Cook for 15 seconds, stirring turkey sausage _ `�®�} constantly. Stir in beans and 1/4 cup water. Bring to a • 1 TB dried basil, crumbled ' boil. Remove from heat, cover and set aside. • 2 garlic cloves, minced Meanwhile, in a medium saucepan, bring the remain- rti9in 1 3/4 cu sof water to a boil. Stir in the rice. • 16 ounce can no -salt navy or t. 9 p cannellini beans, rinsed and y ; ; Cook using the package directions, omitting the salt drained and margarine. To serve gently stir the rice into the • 2 cups water, divided bean mixture and then gently stir in the spinach and • 1 1/2 cups uncooked quick-cooking brown rice salt. The heat of the other ingredients gently warms • 2 cups coarsely chopped spinach leaves and wilts the spinach without leaching out its brilliant • 1/2 tsp. salt color and rich vitamins. Teat a 12 inch nonstick skillet over medium—high 1-1/2 cup a serving, 286 calories. This Mediterranean heat. Remove from heat and lightly spray with vegeta inspired dish is great comfort food when you have to ble oil spray (being careful not to spray near a gas make something quick. S flame). 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FREE ADULT HEPATITIS C TESTING . 3 , 4. ,,, ‘,‘,1,,,'-P,ti1..',.:j1‘,-,.-i•1114i',.*x'.7st,.t.i1:,„_t"4AA—...4`„',.:.,..,-,,)°-'lt,i-1',,',,'t'.,11%,',l,;-,,,,,-,:-#,-.4.;,*,','. :....,,1/4'f”i'4l4lvi'.,':t 1'"')•'"i","i'L','„\„....:'.I,-_'. For adults with any of the following risks: 4:..'tt:'4''1-'sil,1'lA•-'1i,w'".,li*..i',7'k,'',,:1,', R ` *More than 1 sex artner in the last 6 months -a. Diagnosed with a sexually transmitted disease 1 *Injected or snorted street drugs Tattoos or piercings from a non-professional Exposure to someone else's blood Sex with someone with Hepatitis ALWAYS CONFIDENTIAL For more information call *Diagnosed with Hepatitis C. Jefferson County Public Health {360}385-9400 or come ' . 615 Sheridan, Port Townsend, • next to QFC. ADA(Americans with Disabilities Act).Accommodations will be provided upon request.Please call 3859400 for assistance. ti tiny :III `-' h"..0 'rl C7 ^� (� ^+ n `e--i n C7 t7 C1 �u � b ; ~dam 'v0 `b0) 'tip -0 CD `tip b � -dam ]CC xG xG = G xC xG xG xG xG xG w sv w sv w � w r. � .- �' � w — w w w w W n w � w 0 w o01 CT o � o � oma. c �. o �. o �. °io �. o �. o �. o �. 00 00 00 00 � R. � R` °O RS p0 CN RO °0 On 00 socp ma I.,..,.T. 17c�9 c CDt_n 4=, pN co pcxo SQ CD C:' CD oC P � ? O � O +mss ,C) ?'C 0v � t3 pO pts • o n o n o (,-) o n o n o n o n o (-) o n o n CCD (tH coo coo c`3o ,„(°-1 H CD ”3 '-3 co co Jefferson County School Based Health Center Data January 2009 Parent Survey In the summer of 2008 a questionnaire was designed and distributed to parents of students at Port Townsend High School and Chimacum High School. • Parent survey participants: 165 12% of parents reported that in the last year they have had trouble getting medical care for their child. The top reasons given for trouble getting medical care: • Long wait to get an appointment • Services cost too much • No health insurance Parents reported that they think their child would use the school based health center for the following services: • Care for illness or injury (65%) • Physical exam or sports physical (61%) • Immunizations (44%) • Physical activity information (40%) • Nutrition information (34%) 75% of parents reported they would give their child permission to use the school based health center. Another 17% reported being unsure if they would give their child permission. • Student Survey In the fall of 2008 a questionnaire was designed and distributed to students attending Port Townsend High School and 12th .' Chimacum High School. 11th 25% • Student survey participants: 604 - • Participants by grade level: loth 23% Students reported that they believe the following are major health related problems they face that would be helped by Stn 299 health education and prevention programs: • Nutrition and weight issues (31%) 0% 10% 20% 30% • Stress (26%) • Tobacco, alcohol and drug use (17%) • Lack of regular physical activity (17%) • Depression (16%) Students gave the following reasons for using a School Based Health Center: • Location convenient/easy access (50%) • Affordable (41%) • • Care for illness, infection, or injury (31%) • Annual check-up, sports exams (31%) • Confidential/private (29%) Jefferson County Public Health